Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management.
OBJECTIVE
Longer life expectancies and differences in the underlying disease in children with aneurysms raise important issues concerning the choice of microsurgical or endovascular therapy. The authors reviewed their experience at one institution regarding patients treated between 1977 and 2003, focusing on the issue of treatment durability.


METHODS
Forty-three aneurysms in 32 pediatric patients were identified. The patients ranged in age from 2 months to 18 years (mean 11.7 years). Only seven patients (22%) presented with subarachnoid hemorrhage, and in nine patients (28%) significant medical comorbidities were present. Aneurysm locations included the internal carotid artery (13 lesions), middle cerebral artery (11 lesions), and the basilar artery/vertebrobasilar junction (six lesions). Of the 43 lesions, 17 (40%) were giant aneurysms and 22 (51%) exhibited fusiform/dolichoectatic morphological features. Thirteen patients underwent microsurgery, 16 endovascular treatment, and three observation. Complete aneurysm obliteration rates were 94 and 82% in the microsurgical and endovascular groups, respectively. There were no deaths in either group, and neurological morbidity rates were comparable. Over time, 14% of endovascularly treated aneurysms recurred, and in 19% of these patients de novo aneurysms developed (mean follow-up duration 5.7 years). In contrast, there were no recurrences in the microsurgically treated aneurysms and only one de novo aneurysm (6%).


CONCLUSIONS
Both microsurgical and endovascular therapies can be conducted safely to treat pediatric aneurysms. Microsurgery may be more efficacious in completely eliminating the aneurysm and its effects more durable over the extended lifetime of these patients. Parental biases toward nonoperative therapy should be thoroughly addressed before ultimately selecting a treatment strategy.
Sanai
Nader
N
Department of Neurological Surgery, University of California at San Francisco, California 94143-0112, USA.
Quinones-Hinojosa
Alfredo
A
Gupta
Nalin M
NM
Perry
Victor
V
Sun
Peter P
PP
Wilson
Charles B
CB
Lawton
Michael T
MT
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008017:Life Expectancy; D008297:Male; D008866:Microsurgery; D019635:Neurosurgical Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome