title: Middle cerebral artery aneurysms in children: case series and review.
abstract: OBJECTIVE
  Pediatric intracranial aneurysms are rare lesions that differ from their adult counterparts. Aneurysms involving the middle cerebral artery (MCA) are particularly challenging to treat in children, as they are often fusiform and cannot undergo direct clipping alone. The authors recently treated a patient with a heavily calcified, dysplastic, left-sided MCA aneurysm. The present study was performed to evaluate the authors' previous operative and follow-up experience with these difficult lesions.
  
  
  METHODS
  The authors performed a review of a prospectively maintained database of all aneurysms treated at Methodist Hospital in Indianapolis, Indiana, from January 1990 through November 2010. Relevant operative notes, clinical charts, and radiological reports were reviewed for all patients 18 years of age or younger.
  
  
  RESULTS
  A total of 2949 patients with aneurysms were treated over the study period, including 28 children (0.95%). Seven children harbored MCA aneurysms. Five of these 7 aneurysms (71.4%) were fusiform. Two patients were treated with direct clipping, 2 underwent parent vessel occlusion without bypass, and 3 underwent aneurysm trapping with extracranial-intracranial vessel bypass. Long-term follow-up data were available in 6 cases. All 6 patients had a 1-year follow-up Glasgow Outcome Scale score of 5. Long-term radiological follow-up was available in 4 patients. One patient required a reoperation for a recurrent aneurysm 4 years after the initial surgery.
  
  
  CONCLUSIONS
  Middle cerebral artery aneurysms in children are often fusiform, giant, and incorporate the origins of proximal artery branches. Direct clipping may not be possible; trapping of the lesion may be required. Children seem to tolerate surgical trapping with or without bypass extremely well. Aggressive therapy of these rare lesions in children is warranted, as even patients presenting with a poor clinical grade may have excellent outcomes. Long-term surveillance imaging is necessary because of the risk of aneurysm recurrence.
authors: Department of Neurosurgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana 46202-5200, USA. dfulkers@iupui.edu
authors: Daniel H
authors: DH
authors: Fulkerson
authors: Jason M
authors: JM
authors: Voorhies
authors: Troy D
authors: TD
authors: Payner
authors: Thomas J
authors: TJ
authors: Leipzig
authors: Terry G
authors: TG
authors: Horner
authors: Kathleen
authors: K
authors: Redelman
authors: Aaron A
authors: AA
authors: Cohen-Gadol
mesh_terms: D000293:Adolescent; D002114:Calcinosis / Q000175:diagnosis / Q000601:surgery; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed