Philippine Journal of Surgical Specialties Vol. 78, No. 2, July-December 2023, pp 40-44

A Case Report of an Intracranial Giant Aneurysm in a 10-Year-Old Female

Author(s): Emmanuel E. Albano Jr, MD and Reynaldo Benedict V. Villamor Jr, MD, FAFN

Pediatric intracranial aneurysms are rare and differ from aneurysms in adults in terms of location, etiology, natural history and management. This is a case report of giant aneurysm in a 10-year-old patient presenting with symptoms of headache and vomiting. Cerebral catheter angiogram revealed a large aneurysm in the left middle cerebral artery, M1 segment. The patient underwent left pterional craniotomy, clip reconstruction of the patent artery, and aneurysmectomy. Post operatively the patient had an unremarkable course and was discharged improved after 1 week. Cerebral catheter angiogram was performed after 2 months and revealed no residual aneurysm.

Intracranial aneurysms in children are rare; 0.5% to 4.6% of intracranial aneurysms occur in patients aged 18 years or younger. Aneurysms occurring in very young children and infants are exceedingly rare. Unlike their adult counterparts, pediatric aneurysms have been reported to exhibit features such as male predominance, a higher incidence in locations such as the internal carotid bifurcation and posterior circulation, and greater numbers of giant aneurysms. By far, pediatric aneurysms present more commonly as subarachnoid hemorrhage, with peaks at ages 2-5 years and in adolescents older than 15 years. However, the rate of subarachnoid hemorrhage in children is far lower than in adults. This may be due to high incidence of giant aneurysms that present as space-occupying lesions rather than hemorrhage. In the Philippines, intracranial aneurysms are more common in adults rather that in children. Moreover, there has been no published data about pediatric intracranial aneurysm.

Presented here is a case of a 10-year-old female with left middle cerebral artery (MCA) giant aneurysm. This report discusses the epidemiology, signs and symptoms and management of the pediatric patient with a giant aneurysm.

Intracranial aneurysms in children differ from those in adults in location, morphology, etiology, natural history, and management. Giant aneurysms produce neurologic compromise related to mass effect. The most efficacious form of treatment involves complete elimination of this lesion from cerebral circulation. Regardless of whether these aneurysms are treated or observed, children with intracranial aneurysms require follow-up imaging and clinical surveillance, given their expected long-life span during which treated aneurysms could recur or additional aneurysms could arise.

Key words: pediatric, giant aneurysm, craniotomy, clip reconstruction, aneurysmectomy