title: Ruptured dissecting vertebrobasilar aneurysm in childhood: what is the therapeutic strategy?
abstract: OBJECTIVE
  Pediatric aneurysms are rare, accounting for 0.5-4.6% of all intracranial aneurysms. Dissecting vertebrobasilar aneurysms (DVBA) are more frequently observed among children than adults. Cases acutely presenting with subarachnoid hemorrhage need a prompt treatment because of the higher mortality related to untreated cases. Options for an active DVBA management depend on the features of the malformation and include endovascular and surgical approaches.
  
  
  METHODS
  We refer to an 8-year-old healthy female, who presented with a sudden severe headache and vomit, followed by a half-hour loss of consciousness. A CT scan revealed subarachnoid hemorrhage, and brain MR angiography showed a lesion with mass effect on bulbar structures, suggestive of an aneurysm of the vertebrobasilar junction. The intracranial angiography confirmed this diagnosis and showed a relevant revascularization coming from the anterior cerebral circulation.
  
  
  RESULTS
  Endovascular treatment was considered as a suitable option and occlusion of both vertebral arteries, saving the left posterior inferior cerebellar artery, was performed. No neurological deficits appeared after embolization, and the patient was clinically stable at 18 months of follow-up.
  
  
  CONCLUSIONS
  In the 'stent era', parent vessel deconstruction throughout endovascular balloon or coil occlusion could be considered in patients with a sound collateral circulation and when cerebellar hemisphere and encephalic trunk feeding is not compromised.
authors.affiliation: Division of Neurosurgery, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy. michele.rizzi@live.it
authors.forename: Michele
authors.initials: M
authors.lastname: Rizzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Benedictis
authors.forename: Carlo Efisio
authors.initials: CE
authors.lastname: Marras
authors.forename: Paolo
authors.initials: P
authors.lastname: Palma
authors.forename: Flora
authors.initials: F
authors.lastname: Desiderio
authors.forename: Massimo
authors.initials: M
authors.lastname: Rollo
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging* / Q000601:surgery*