Intracranial Aneurysms in Childhood: Report of 8 Cases and Review of the Literature

J. Regelsberger; O. Heese; T. Martens; T. Ries; P. Kunkel; M. Westphal

doi:10.1055/s-0028-1093353

Central European Neurosurgery - Zentralblatt für Neurochirurgie, Table of Contents

Cent Eur Neurosurg 2009; 70(2): 79-85
DOI: 10.1055/s-0028-1093353

Review

Intracranial Aneurysms in Childhood: Report of 8 Cases and Review of the Literature

Intrakranielle Aneurysmen im Kindesalter: 8 Fälle und Auswertung der LiteraturJ. Regelsberger¹ , O. Heese¹ , T. Martens¹ , T. Ries¹ , P. Kunkel¹ , M. Westphal¹

¹Neurochirurgische Klinik, Universitätsklinikum Hamburg – Eppendorf, Germany

Abstract

Objective: Subarachnoid haemorrhage (SAH) due to ruptured cerebral aneurysms is a rare diagnosis in childhood and is believed to differ from that in adults with regard to sex, aneurysm size and location, clinical appearance as well as outcome, suggesting that aneurysms in childhood are a distinct entity.

Patients and Methods: Seven children and young adults with a mean age of 13.6 years suffered from aneurysmal subarachnoid haemorrhage. On admission two patients were Hunt & Hess (HH) grade I, four were grade III and one was grade V. In addition, there was one 14-year-old boy who presented with seizures and was found to have a non-ruptured aneurysm of the basilar tip. Overall, there were two female and six male patients. Anterior circulation aneurysms were diagnosed in five patients whereas three patients suffered from posterior circulation aneurysm. Five large (10–25 mm) aneurysms and three smaller than 10 mm were found. Surgical clipping of the aneurysms was performed in all patients.

Results: Six patients showed no significant disability or no symptoms at all when evaluated with the modified Rankin Scale (mRS 0 or 1). One patient suffered from persisting nerve palsies (mRS 2) and one 6-year-old boy, admitted with HH grade V, died due to the initial poor clinical condition followed by severe brain oedema and secondary complications.

Conclusions: Reviewing the literature, a male predominance, low rate of SAH, high percentage of complex aneurysms and of aneurysms located in the posterior circulation are characteristic features of aneurysms in childhood. Once a cerebral aneurysm is diagnosed in the younger age group, definite therapy should be performed soon as the outcome is expected to be more favourable than in adulthood.

Zusammenfassung

Hintergrund: Die aneurysmatische Subarachnoidalblutung (SAB) im Kindesalter ist eine sehr seltene Diagnose und ist nach Angaben der Literatur hinsichtlich der klinischen Daten, Aneurysmagröße und –lokalisation sowie der therapeutischen Ergebnisse deutlich von denen im Erwachsenenalter zu unterscheiden.

Patienten und Methodik: Sieben Kinder und Jugendliche mit mittlerem Lebensalter von 13,6 Jahren wurden mit einer SAB (Hunt & Hess Grad I bis V) operativ behandelt. Bei einem weiteren Patienten (14 Jahre) mit zerebralen Krampfanfällen wurde ein nicht rupturiertes Basilaris-Kopf-Aneurysma ebenfalls neurochirurgisch versorgt. Aneurysmen des vorderen Kreislaufes wurden bei fünf Kindern, des vertebrobasilären Kreislaufes bei drei Kindern diagnostiziert. 5 von 8 Aneurysmen waren zwischen 10 und 25 mm groß, 3 waren kleiner als 10 mm.

Ergebnisse: Sechs Patienten zeigten nach der Behandlung keine oder nur eine geringe Einschränkung (modified Rankin Scale 0 oder 1), während ein Patient dauerhafte Hirnnervenstörungen erlitt und einer an der Schwere der SAB, Hirnödem mit pulmonalen Komplikationen verstarb.

Schlussfolgerung: Eine Übersicht der Literatur mit mehr als 700 publizierten Fällen zeigt bei Kindern im Gegensatz zu der Gruppe der Erwachsenen eine männliche Dominanz, eine relativ geringe Rate von rupturierten Aneurysmen, einen hohen Prozentsatz von sehr großen oder komplexen Aneurysmen, die zudem weitaus häufiger im hinteren Kreislauf lokalisiert sind. Damit dürfen die Aneurysmen im Kindesalter als eine besondere Entität verstanden werden, die hinsichtlich der Therapie trotz der kritischen Eingangsvoraussetzungen eine sehr günstige Prognose besitzen.

Key words

spontaneous subarachnoid haemorrhage - cerebral aneurysm - childhood

Schlüsselwörter

Subarachnoidalblutung - zerebrale Aneurysmen - Kindesalter

Full Text

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Correspondence

PD Dr. J. Regelsberger

Neurochirurgische Klinik

Universitätsklinikum Hamburg – Eppendorf

Martinistr. 52

20249 Hamburg

Germany

Phone: +49/404/2803 37 51

Fax: +49/404/2803 74 06

Email: j.regelsberger@uke.uni-hamburg.de