Middle cerebral artery aneurysms in children

Case series and review - Clinical article

Daniel H. Fulkerson, Jason M. Voorhies, Troy D. Payner, Thomas J. Leipzig, Terry G. Horner, Kath Leen Redelman, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Object. Pediatric intracranial aneurysms are rare lesions that differ from their adult counterparts. Aneurysms involving the middle cerebral artery (MCA) are particularly challenging to treat in children, as they are often fusiform and cannot undergo direct clipping alone. The authors recently treated a patient with a heavily calcified, dysplastic, left-sided MCA aneurysm. The present study was performed to evaluate the authors' previous operative and follow-up experience with these difficult lesions. Methods. The authors performed a review of a prospectively maintained database of all aneurysms treated at Methodist Hospital in Indianapolis, Indiana, from January 1990 through November 2010. Relevant operative notes, clinical charts, and radiological reports were reviewed for all patients 18 years of age or younger. Results. A total of 2949 patients with aneurysms were treated over the study period, including 28 children (0.95%). Seven children harbored MCA aneurysms. Five of these 7 aneurysms (71.4%) were fusiform. Two patients were treated with direct clipping, 2 underwent parent vessel occlusion without bypass, and 3 underwent aneurysm trapping with extracranial-intracranial vessel bypass. Long-term follow-up data were available in 6 cases. All 6 patients had a 1-year follow-up Glasgow Outcome Scale score of 5. Long-term radiological follow-up was available in 4 patients. One patient required a reoperation for a recurrent aneurysm 4 years after the initial surgery. Conclusions. Middle cerebral artery aneurysms in children are often fusiform, giant, and incorporate the origins of proximal artery branches. Direct clipping may not be possible; trapping of the lesion may be required. Children seem to tolerate surgical trapping with or without bypass extremely well. Aggressive therapy of these rare lesions in children is warranted, as even patients presenting with a poor clinical grade may have excellent outcomes. Long-term surveillance imaging is necessary because of the risk of aneurysm recurrence.

Original languageEnglish
Pages (from-to)79-89
Number of pages11
JournalJournal of Neurosurgery: Pediatrics
Volume8
Issue number1
DOIs
StatePublished - Jul 2011

Fingerprint

Intracranial Aneurysm
Aneurysm
Glasgow Outcome Scale
Reoperation
Arteries
Databases
Pediatrics
Recurrence

Keywords

  • Aneurysm trapping
  • Extracranial-intracranial bypass
  • Fusiform aneurysm
  • Middle cerebral artery
  • Vascular disorders

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Fulkerson, D. H., Voorhies, J. M., Payner, T. D., Leipzig, T. J., Horner, T. G., Redelman, K. L., & Cohen-Gadol, A. (2011). Middle cerebral artery aneurysms in children: Case series and review - Clinical article. Journal of Neurosurgery: Pediatrics, 8(1), 79-89. https://doi.org/10.3171/2011.4.PEDS10583

Middle cerebral artery aneurysms in children : Case series and review - Clinical article. / Fulkerson, Daniel H.; Voorhies, Jason M.; Payner, Troy D.; Leipzig, Thomas J.; Horner, Terry G.; Redelman, Kath Leen; Cohen-Gadol, Aaron.

In: Journal of Neurosurgery: Pediatrics, Vol. 8, No. 1, 07.2011, p. 79-89.

Research output: Contribution to journalArticle

Fulkerson, Daniel H. ; Voorhies, Jason M. ; Payner, Troy D. ; Leipzig, Thomas J. ; Horner, Terry G. ; Redelman, Kath Leen ; Cohen-Gadol, Aaron. / Middle cerebral artery aneurysms in children : Case series and review - Clinical article. In: Journal of Neurosurgery: Pediatrics. 2011 ; Vol. 8, No. 1. pp. 79-89.
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abstract = "Object. Pediatric intracranial aneurysms are rare lesions that differ from their adult counterparts. Aneurysms involving the middle cerebral artery (MCA) are particularly challenging to treat in children, as they are often fusiform and cannot undergo direct clipping alone. The authors recently treated a patient with a heavily calcified, dysplastic, left-sided MCA aneurysm. The present study was performed to evaluate the authors' previous operative and follow-up experience with these difficult lesions. Methods. The authors performed a review of a prospectively maintained database of all aneurysms treated at Methodist Hospital in Indianapolis, Indiana, from January 1990 through November 2010. Relevant operative notes, clinical charts, and radiological reports were reviewed for all patients 18 years of age or younger. Results. A total of 2949 patients with aneurysms were treated over the study period, including 28 children (0.95{\%}). Seven children harbored MCA aneurysms. Five of these 7 aneurysms (71.4{\%}) were fusiform. Two patients were treated with direct clipping, 2 underwent parent vessel occlusion without bypass, and 3 underwent aneurysm trapping with extracranial-intracranial vessel bypass. Long-term follow-up data were available in 6 cases. All 6 patients had a 1-year follow-up Glasgow Outcome Scale score of 5. Long-term radiological follow-up was available in 4 patients. One patient required a reoperation for a recurrent aneurysm 4 years after the initial surgery. Conclusions. Middle cerebral artery aneurysms in children are often fusiform, giant, and incorporate the origins of proximal artery branches. Direct clipping may not be possible; trapping of the lesion may be required. Children seem to tolerate surgical trapping with or without bypass extremely well. Aggressive therapy of these rare lesions in children is warranted, as even patients presenting with a poor clinical grade may have excellent outcomes. Long-term surveillance imaging is necessary because of the risk of aneurysm recurrence.",
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