The Pipeline embolization device for the treatment of intracranial aneurysms in pediatric patients with tuberous sclerosis complex: illustrative cases

BACKGROUND Tuberous sclerosis complex (TSC) is a neurocutaneous disorder characterized by the multisystem development of benign tumors. Patients with TSC are also at an increased risk of developing intracranial aneurysms early in life. While aneurysms have historically been treated with open surgical clipping, endovascular approaches are increasingly being used in both pediatric and adult populations. OBSERVATIONS In this case series, the authors report the endovascular treatment of three young patients with TSC and fusiform intracranial aneurysms using the Pipeline embolization device (PED) for flow diversion of the affected artery. In all cases, complete aneurysm occlusion was observed, with good parent artery wall reconstruction and no parent artery stenosis or occlusion. All flow diverter stents were deployed successfully, and there were no device-related complications. All patients were maintained on dual antiplatelet therapy. LESSONS The PED can serve as a safe and effective endovascular alternative to open surgery for the treatment of intracranial aneurysms in young patients with TSC. This could avoid an additional craniotomy in a population already likely to require surgical intervention for TSC-related tumors or epilepsy. Further studies investigating the use of the PED in the pediatric population must be undertaken to validate its long-term efficacy.