Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging

Michael George Zaki Ghali, Visish M. Srinivasan, Jacob Cherian, Louis Kim, Adnan Siddiqui, M. Ali Aziz-Sultan, Michael Froehler, Ajay Wakhloo, Eric Sauvageau, Ansaar Rai, Stephen R. Chen, Jeremiah Johnson, Sandi K. Lam, Peter Kan

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations

Abstract

Background Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking. Methods We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience. Results Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping. Conclusions We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.

Original languageEnglish (US)
Pages (from-to)418-431
Number of pages14
JournalWorld neurosurgery
Volume109
DOIs
StatePublished - Jan 2018

Keywords

  • Aneurysms
  • CTA
  • DSA
  • Imaging
  • Intracranial
  • MRA
  • Pediatric

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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