Aneurysmal disease in children. Review of 20 cases with intracranial arterial localisations.

SUMMARY: Twenty children (13 males, 7 females), referred to our group with non traumatic intracranial aneurysms between 1978 and January 1997, were included in this study. Their angiograms were reviewed to assess number, location, type of aneurysms and evolution before and after treatment. Their ages ranged from 1 month to 15 years. Seven patients (35%) presented with subarachnoid haemorrhage (SAH). Eleven patients (55%) presented with focal neurological deficits or seizures: epileptic seizures occurred in five patients, neurologic deficits or focal symptoms due to mass effect occurred in six. Total number of diagnosed intracranial aneurysms was 24. The most common sites involved were internal carotid (37%) and vertebrobasilar (32%) systems. The aetiology of the aneurysms was infective in four patients and unknown in the remaining 16 patients (80%). Endovascular treatment was successful in seven patients (37%). Three patients (15%) were surgically treated. Seven patients (35%) were conservatively treated. Two patients (10%) had spontaneous thrombosis of the aneurysm. SAH was more frequent in males, and never occurred in children under five years old. Frequent presentations such as focal symptoms or mass effect and less prevalence of aneurysm rupture are probably due to the high prevalence of large or giant aneurysms (25%) in our series. In conclusion, radiological findings and the natural history of symptomatic arterial aneurysms in children are clearly different from those in adults. Probably pathogenetic factors and aetiology are also different. Shear stresses, haemodynamic and hormonal factors do not appear to be dominant to reveal such defects, though their correction favours repair. Since repair is frequent, conservative treatment has a major role in their aneurysm management.