title: Endovascular and surgical treatment of ruptured cerebral aneurysms in pediatric patients.
abstract: OBJECTIVE
  Pediatric cerebral aneurysms are rare. There are very few recent studies that focus on the multidisciplinary treatment of ruptured aneurysms. We reviewed our pediatric endovascular and surgical experience with ruptured cerebral aneurysms.
  
  
  METHODS
  Pediatric patients aged 16 years and younger who were admitted with a diagnosis of aneurysmal subarachnoid hemorrhage and treated at the Children's Hospital of Philadelphia were included in this analysis.
  
  
  RESULTS
  Twelve patients with 13 aneurysms (4 male patients and 8 female patients; age range, 4 months-16 years; mean age, 5.1 years), were admitted with subarachnoid hemorrhage during the past 12 years. The majority of patients were admitted in good clinical condition; 31% were in Hunt and Hess Grade II, and 31% were in Hunt and Hess Grade III. The remaining patients were in poor clinical condition and were in Hunt and Hess Grade IV (23%) or Grade V (15%). Computed tomography revealed that 15% of the patients were in Fisher Grade 2, 23% were in Fisher Grade 3, and 62% were in Fisher Grade 4. Endovascular techniques were used in the treatment of 5 aneurysms, and microsurgery was used in the treatment of 8 aneurysms. In the endovascular group, aneurysm sizes ranged from 2 to 35 mm (mean, 12.6 mm); 3 aneurysms were in the anterior circulation, and 2 were in the posterior circulation. In the microsurgery group, 6 aneurysms were in the anterior circulation, and 2 were in the posterior circulation; sizes ranged from 3 to 15 mm (mean, 6.8 mm). Sixty-nine percent of the patients were independent at follow-up.
  
  
  CONCLUSIONS
  Contemporary endovascular and microsurgical techniques can be used effectively to treat ruptured cerebral aneurysms in pediatric patients. In the time period studied, the techniques were equally effective when used in the appropriate patients.
authors.affiliation: Department of Neurosurgery and Division of Interventional Neuroradiology, University of Pennsylvania Medical Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stiefel
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Heuer
authors.forename: Anuj K
authors.initials: AK
authors.lastname: Basil
authors.forename: John B
authors.initials: JB
authors.lastname: Weigele
authors.forename: Leslie N
authors.initials: LN
authors.lastname: Sutton
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hurst
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Storm
mesh_terms: D000293:Adolescent; D017542:Aneurysm, Ruptured / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects