Abstract
Introduction
Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery.
Methods
Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm.
Results
The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome.
Conclusion
Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children.
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References
Lasjaunias P (ed) (1997) Vascular diseases in neonates, infants and children. Springer, Berlin Heidelberg New York, pp 373–392
McDonald PJ, Wallace MC (2003) Pediatric intracranial aneurysms. In: Leroux P, Winn HR, Newell D (eds) Management of cerebral aneurysms. Saunders, Philadelphia, pp 357–362
Huang J, McGirt M, Gailloud P, Tamargo R (2005) Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol 63:424–433
Lasjaunias P, Wuppalapati S, Alvarez H et al (2005) Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 21:437–450
Ostergaard JR, Voldby B (1983) Intracranial arterial aneurysms in children and adolescents. J Neurosurg 58(6):832–837
Meyer FB, Sundt TM Jr, Fode NC, Morgan MK, Forbes GS, Mellinger JF (1989) Cerebral aneurysms in childhood and adolescence. J Neurosurg 70(3):420–425
Patel AN, Richardson AE (1971) Ruptured intracranial aneurysms in the first two decades of life. A study of 58 patients. J Neurosurg 35(5):571–576
Putty TK, Luerssen TG, Campbell RL, Boaz JC, Edwards MK (1990–1991) Magnetic resonance imaging diagnosis of a cerebral aneurysm in an infant. Case report and review of the literature. Pediatr Neurosurg 16:48–51
Locksley HB, Sahs AL, Knowler L (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V, part I. natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25:219–239
Weir BK, Macdonald RL (1996) Intracranial aneurysms and subarachnoid hemorrhage: an overview. In: Wilkins RR, Rengachary SA (eds) Neurosurgery. New York, McGraw-Hill, pp 2191–2213
Allison JW, Davis PC, Sato Y, James CA, Haque SS, Angtuaco EJ, Glasier CM (1998) Intracranial aneurysms in infants and children. Pediatr Radiol 28(4):223–229
Schievink WI, Mokri B, Piepgras DG (1994) Spontaneous dissections of cervicocephalic arteries in childhood and adolescence. Neurology 44(9):1607–1612
Ganesan V, Chong WK, Cox TC, Chawda SJ, Prengler M, Kirkham FJ (2002) Posterior circulation stroke in childhood: risk factors and recurrence. Neurology 59(10):1552–1556
Fullerton HJ, Johnston SC, Smith WS (2001) Arterial dissection and stroke in children. Neurology 57(7):1155–1160
Vilela P, Goulão A (2003) Cervical and intracranial arterial dissection: review of the acute clinical presentation and imaging of 48 cases. Acta Med Port 16(3):155–164
Laughlin S, terBrugge K, Willinsky R et al (1997) Endovascular management of pediatric aneurysms. Intervent Neuroradiol 3:205–214
Berenstein A, Lasjaunias P, terBrugge K (eds) (2001) Surgical neuroangiography: clinical and endovascular treatment aspects in adults. Springer, Berlin Heidelberg New York, pp 365–564
Sasaki O, Koizumi T, Ito Y, Sorimachi T, Koike T, Tanaka R (1992) Dissecting aneurysm of the posterior cerebral artery treated with proximal ligation. Surg Neurol 37(5):394–401
Kitanaka C, Tanaka J, Kuwahara M, Teraoka A, Sasaki T, Takakura K, Tanaki J (1994) Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80(4):667–674
Hosoya T, Adachi M, Yamaguchi K, Haku T, Kayama T, Kato T (1999) Clinical and neuroradiology features of intracranial vertebrobasilar dissection. Stroke 30:1083–1090
Massimi L, Moret J, Tamburrini G, Di Rocco C (2003) Dissecting giant vertebro-basilar aneurysms. Childs Nerv Syst 19(4):204–210
Naito I, Iwai T, Sasaki T (2002) Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage. Neurosurgery 51(4):930–937
Pozzati E, Padovani R, Fabrizi A, Sabattini L, Gaist G (1991) Benign arterial dissections of the posterior circulation. J Neurosurg 75(1):69–72
Nakatomi H, Nagata K, Kawamoto S, Shiokawa Y (1997) Ruptured dissecting aneurysm as a cause of subarachnoid hemorrhage of unverified etiology. Stroke 28(6):1278–1282
Amacher AL, Drake CG, Ferguson GG (1981) Posterior circulation aneurysms in young people. Neurosurgery 8(3):315–320
Storrs BB, Humphreys RP, Hendrick EB, Hoffman HJ (1982) Intracranial aneurysms in the pediatric age-group. Childs Brain 9(5):358–361
Ferrante L, Acqui M, Trillo G, Lunardi P, Fortuna A (1996) Aneurysms of the posterior cerebral artery: do they present specific characteristics? Acta Neurochir (Wien) 138(7):840–852
Seoane ER, Tedeschi H, de Oliveira E, Siqueira MG, Calderon GA, Rhoton AL Jr (1997) Management strategies for posterior cerebral artery aneurysms: a proposed new surgical classification. Acta Neurochir (Wien) 139(4):325–331
Day A, Gaposchkin CG, Yu C, Rivet D, Dacey R (2003) Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 99:228–240
Simpson RK Jr, Parker WD (1986) Distal posterior cerebral artery aneurysm. Case report. J Neurosurg 64(4):669–672
Sundt TM (ed) (1990) Surgical techniques for saccular and giant intracranial aneurysms. Williams & Wilkins, Baltimore, pp 198–210
de Sousa AA, Dantas FL, Neto AP, Carvalho GT (1996) Giant posterior cerebral artery aneurysm in a 4-year-old child: case report. Surg Neurol 45(1):31–35
Hayman JA, Anderson RM (1996) Dissecting aneurysm of the basilar artery. Med J Aust 2(8):360–361
Schoenberg BS, Mellinger JF, Schoenberg DG (1978) Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival. Neurology 28(8):763–768
Kim SH, Kosnik E, Madden C, Rusin J, Wack D, Bartkowski H (1997) Cerebellar infarction from a traumatic vertebral artery dissection in a child. Pediatr Neurosurg 27(2):71–77
Silverboard G, Tart R (2000) Cerebrovascular arterial dissection in children and young adults. Semin Pediatr Neurol 7(4):289–300
Ciceri EF, Klucznik RP, Grossman RG, Rose JE, Mawad ME (2001) Aneurysms of the posterior cerebral artery: classification and endovascular treatment. AJNR Am J Neuroradiol 22(1):27–34
Edner G, Forster DM, Steiner L, Bergvall U (1978) Spontaneous healing of intracranial aneurysms after subarachnoid hemorrhage. Case report. J Neurosurg 48(3):450–454
Andrews BT, Edwards MS, Gannon P (1984) Acutely thrombosed aneurysm of the middle cerebral artery presenting as intracranial hemorrhage in a 3-year-old child. Case report. J Neurosurg 60(6):1303–1307
Davila S, Oliver B, Molet J, Bartumeus F (1984) Spontaneous thrombosis of an intracranial aneurysm. Surg Neurol 22(1):29–32
Waga S, Tochio H (1985) Intracranial aneurysm associated with moyamoya disease in childhood. Surg Neurol 23(3):237–243
Choudhury AR, al Amiri NH, al Moutaery KR, Aabed M, Strelling MK (1991) Giant middle cerebral aneurysm presenting as hemiathetosis in a child and its spontaneous thrombosis. Childs Nerv Syst 7(1):59–61
Tanabe M, Inoue Y, Hori T (1991) Spontaneous thrombosis of an aneurysm of the middle cerebral artery with subarachnoid haemorrhage in a 6-year-old child: case report. Neurol Res 13(4):202–204
Maeda K, Usui M, Tsutsumi K, Iijima A (1997) Spontaneous occlusion of a giant basilar tip aneurysm and a basilar artery due to the dissection of both structures: case report. Surg Neurol 48(6):606–609
Loevner LA, Ting TY, Hurst RW, Goldberg HI, Schut L (1998) Spontaneous thrombosis of a basilar artery traumatic aneurysm in a child. AJNR Am J Neuroradiol 19(2):386–388
Moron F, Benndorf G, Akpek S, Dempsy R, Strother CM (2005) Spontaneous thrombosis of a traumatic posterior cerebral artery aneurysm in a child. AJNR Am J Neuroradiol 26(1):58–60
Nass R, Hays A, Chutorian A (1982) Intracranial dissecting aneurysms in childhood. Stroke 13(2):204–207
Piske RL, Darwich R, Campos C, Fonseca N et al (1998) Spontaneous resolution of ruptured dissecting PICA aneurysm. Report of two cases. Interv Neuroradiol 4:287–292
Ciceri EF, Lawhead AL, De Simone T, Valvassori L, Boccardi E (2005) Spontaneous partial thrombosis of a basilar artery giant aneurysm in a child. AJNR Am J Neuroradiol 26(1):56–57
Black S, German W (1960) Observations of the relationship between the volume and the size of the orifice of the experimental aneurysms. J Neurosurg 17:984–990
Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21(11):1628–1631
Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72(2):183–188
Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36(5):905–911
Kurata A, Ohmomo T, Miyasaka Y, Fujii K, Kan S, Kitahara T (2001) Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22(1):11–18
Mizutani T, Kojima H, Asamoto S (2004) Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54(2):342–347
Yamada M, Kitahara T, Kurata A, Fujii K, Miyasaka Y (2004) Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients. J Neurosurg 101(1):25–30
Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28(2):370–374
Terasaka S, Sawamura Y, Kamiyama H, Fukushima T (2000) Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery. Neurosurgery 47(2):359–364
Berger MS, Wilson CB (1984) Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61(5):882–894
Friedman AH, Drake CG (1984) Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60(2):325–334
Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72(2):183–188
Andoh T, Shirakami S, Nakashima T et al (1992) Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987–993
Steinberg GK, Drake CG, Peerless SJ (1993) Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg 79(2):161–173
Durward QJ (1995) Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82(1):137–139
Yamaura I, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, Matsumoto T (1999) Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90(5):853–856
Solomon R (2000) Discussion on: Terasaka S, Sawamura Y, Kamiyama H, Fukushima T. Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery. Neurosurgery 47(2):365
Taylor C, Kopitnik T, Samson D, Purdy P (2003) Treatment and outcome in 30 patients with posterior cerebral artery aneurysms. J Neurosurg 99:15–22
Gerber C, Neil-Dwyer G, Evans B (1993) An alternative surgical approach to aneurysms of the posterior cerebral artery. Neurosurgery 32:928–931
Hallacq P, Piotin M, Moret J (2002) Endovascular occlusion of the posterior cerebral artery for the treatment of p2 segment aneurysms: retrospective review of a 10-year series. AJNR Am J Neuroradiol 23:1128–1136
Vishteh A, Smith, Kris A, McDougall C, Spetzler R (1998) Distal posterior cerebral artery revascularization in multimodality management of complex peripheral posterior cerebral artery aneurysms: technical case report. Neurosurgery 43:166–170
Drake CG (1997) Giant posterior cerebral aneurysms: 66 patients. In: Drake CG, Peerless SJ, Hernesniemi JA (eds.) Surgery of vertebrobasilar aneurysms: London, Ontario, Experience on 1767 patients. Springer, Berlin Heidelberg New York, pp 230–248
Zeal AA, Rhoton AL Jr (1978) Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 48:534–559
Fletcher TM, Taveras JM, Pool JL (1959) Cerebral vasospasm in angiography for intracranial aneurysms. Incidence and significance in one hundred consecutive angiograms. Arch Neurol 1:38
Lin JP (1969) Thrombosis of aneurysm of anterior communicating artery. Case report. Acta Radiol 8:74–80
Spetzler R, Winestock D, Newton H et al (1974) Disappearance and reappearance of cerebral aneurysm in serial arteriograms. Case report. J Neurosurg 41:508–510
Fodstad H, Liliequist B (1979) Spontaneous thrombosis of ruptures intracranial aneurysms during treatment with tranexamic acid (AMCA). Report of three cases. Acta Neurochir 49:129–144
Atkinson J, Lane J, Colbassani H et al (1993) Spontaneous thrombosis of posterior cerebral artery aneurysm with angiographic reappearance. J Neurosurg 79:434–437
Lee KC, Joo JY, Lee KS, Shin YS (1999) Recanalization of completely thrombosed giant aneurysm: case report. Surg Neurol 51(1):94–98
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Vilela, P., Goulão, A. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature. Neuroradiology 48, 541–548 (2006). https://doi.org/10.1007/s00234-006-0086-z
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DOI: https://doi.org/10.1007/s00234-006-0086-z