title: Intracranial aneurysms in the youngest patients: characteristics and treatment challenges.
abstract: BACKGROUND
  Characteristics and treatment challenges of aneurysms in young children differ from those in older pediatric patients.
  
  
  METHODS
  Records of children undergoing cerebral or spinal angiography by the senior neurointerventionalist (D.B.O.) from October 2006 to January 2014 were reviewed to identify patients with digital subtraction angiography-confirmed intracranial aneurysms. Demographics, presentation, subtype of aneurysm, treatment strategy, and outcome were evaluated.
  
  
  RESULTS
  Of 763 pediatric cases, 33 were of children harboring cerebral aneurysms. Overall, 48% were male, 24% presented with hemorrhage and 67% harbored fusiform/dissecting aneurysms. Patients aged 0-10 years were significantly more likely to harbor nonsaccular, dissecting/fusiform aneurysms (84 vs. 43%, p = 0.02). A total of 13/22 pediatric patients harboring dissecting/fusiform aneurysms were male (59%) compared to 3/11 with saccular aneurysms (27%, p = 0.14). Overall, 15 patients underwent endovascular treatment (45%) and 8 underwent microsurgical treatment (24%). There was no significant difference in treatment approach based on patient age or aneurysm morphology. Overall, 19/23 aneurysms were occluded after initial treatment (83%); there were 2 procedure-related complications with neurological sequelae (9%).
  
  
  CONCLUSIONS
  We demonstrate that the youngest patients (10 years and under) have aneurysms even more distinct and less similar to adult aneurysms than those in the larger pediatric cohort.
authors.affiliation: Department of Neurological Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass., USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
authors.forename: R Michael
authors.initials: RM
authors.lastname: Scott
authors.forename: Darren B
authors.initials: DB
authors.lastname: Orbach
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome