Cerebral aneurysms in children

Childhood intracranial saccular aneurysms are rare, accounting for only 0.6–4.6% of all aneurysms. This paper presents two such cases. A 12-year-old boy developed sudden severe headaches. CT indicated subarachnoid hemorrhage in the bilateral sylvian fissure. Angiography failed to demonstrate any vascular lesions. Repeat angiography, however, revealed a 2 mm aneurysm on the right A-1. A miniclip was successfully applied to obliterate the aneurysm. The postoperative course was uneventful. In the second case, a 3-year-old boy, CT incidentally revealed a bullet-shaped high density area. Angiography demonstrated a large aneurysm arising from the insular portion of the prefrontal branch of middle cerebral artery. This large aneurysm with a broad-based neck was successfully clipped, employing the angioplastic and/or tandem clipping, despite the fact the prefrontal artery unfortunately was compromised in postoperative angiography. The patient was doing well postoperatively. Spontaneous subarachnoid hemorrhage (SAH) in childhood is uncommon. However, when children with SAH is encountered, angiography should be performed repeatedly even if the first angiogram does not demonstrate any vascular abnormality. Childhood aneurysms are increasingly being found incidentally in CT scans. The differences between child and adult aneurysms in regard to site, size, sex predominance, clinical features, and surgical outcome are discussed.