title: Management of ruptured dissecting intracranial aneurysms in infants: report of four cases and review of the literature.
abstract: BACKGROUND
  Intracranial cerebral aneurysms in the pediatric population are infrequent, and those occurring in infants less than 1 year old are extremely rare. Of intracranial aneurysms in children, dissecting aneurysms are the most common type seen. While spontaneous dissecting aneurysms usually present with ischemia, hemorrhage can also occur.
  
  
  METHODS
  A retrospective review of our patients revealed that from July 1, 2007 to June 30, 2012, four infants were treated for ruptured distal dissecting intracranial aneurysms at Texas Children's Hospital. Mycotic aneurysms and collagen vascular disorder were excluded in all four cases. All patients presented in our series presented with subarachnoid hemorrhage, and three had intraventricular hemorrhage. All patients underwent conventional catheter angiography for diagnosis. All patients in this series were managed in the acute or subacute period with surgical or endovascular trapping without distal bypass procedures. All four patients tolerated sacrifice of the parent vessels feeding these distal aneurysms well.
  We describe the presentation and management of these rare cases and then review the current literature on the management of these dissecting aneurysms in infants.
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA.
authors.forename: Vikas Y
authors.initials: VY
authors.lastname: Rao
authors.forename: Krishna B
authors.initials: KB
authors.lastname: Shah
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Bollo
authors.forename: Michel E
authors.initials: ME
authors.lastname: Mawad
authors.forename: William E
authors.initials: WE
authors.lastname: Whitehead
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Curry
authors.forename: Robert C
authors.initials: RC
authors.lastname: Dauser
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Luerssen
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome