title: Flow diversion for complex intracranial aneurysms in young children.
abstract: Pediatric intracranial aneurysms are exceedingly rare and account for less than 5% of all intracranial aneurysms. Open surgery to treat such aneurysms has been shown to be more durable than endovascular techniques, and durability of treatment is particularly important in the pediatric population. Over the past 2 decades, however, a marked shift in aneurysm treatment from open surgery toward endovascular procedures has occurred for adults. The authors describe their early experience in treating 3 unruptured pediatric brain aneurysms using the Pipeline embolization device (PED). The first patient, a girl with Majewski osteodysplastic primordial dwarfism Type II who was harboring multiple intracranial aneurysms, underwent two flow diversion procedures for a vertebrobasilar aneurysm and a supraclinoid internal carotid artery aneurysm. The second patient underwent PED placement on a previously coiled but enlarging posterior communicating artery aneurysm. All procedures were uneventful, with no postsurgical complications, and led to complete angiographic obliteration of the aneurysms. To the authors' knowledge, this is the first series of flow diversion procedures in children reported in the medical literature. While flow diversion is a new and relatively untested technology in children, outcomes in adults have been promising. For challenging lesions in the pediatric population, flow diversion may have a valuable role as a well-tolerated, safe treatment with durable results. Many issues remain to be addressed, such as the durability of flow diverters over a very long follow-up and vessel response to growth in the presence of an endoluminal device.
authors.affiliation: Endovascular Surgical Neuroradiology, Mayo Clinic;
authors.forename: Ramon
authors.initials: R
authors.lastname: Navarro
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Brown
authors.forename: Alexandra
authors.initials: A
authors.lastname: Beier
authors.forename: Nathan
authors.initials: N
authors.lastname: Ranalli
authors.forename: Philipp
authors.initials: P
authors.lastname: Aldana
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
mesh_terms: D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome
keywords: ACoA = anterior communicating artery; ICA = internal carotid artery; MCA = middle cerebral artery; MOPD = Majewski osteodysplastic primordial dwarfism; PCoA = posterior communicating artery; PED = Pipeline embolization device; Pipeline embolization device; SAH = subarachnoid hemorrhage; VB = vertebrobasilar; flow diversion; intracranial aneurysm; pediatric; vascular disorders