Pediatric Intracranial Pseudoaneurysms: A Report of 15 Cases and Review of the Literature

OBJECTIVE: To summarize the characteristics of intracranial pseudoaneurysms (IPAs) in pediatric patients. METHODS: Pediatric IPAs treated at our center between January 2012 and April 2017 were analyzed retrospectively. Related literature was reviewed, and the results of those studies were compared with our present findings. RESULTS: A total of 15 pediatric IPAs from 64 pediatric intracranial aneurysms (23.4%) were included in our study. Eleven of the 15 patients (73.3%) were male, and 9 (60%) had a history of head trauma. Seven patients (46.6%) presented with seizures, 9 of 11 patients (81.8%) with ruptured aneurysms with presented intracerebral hematoma, and 9 IPAs (60%) were large or giant in size. The internal carotid artery (ICA) and middle cerebral artery (MCA) were the most common aneurysm sites (n = 6; 40.0%). Eight IPAs (53.3%) were distal arterial aneurysms. Seven patients (46.7%) underwent craniotomy surgery, and 8 (53.3%) underwent endovascular treatment. During a mean follow-up of 2.0 +/- 1.3 years, 12 patients (80.0%) had favorable outcomes, with a modified Rankin Scale (mRS) score of 0-2. One patient in the endovascular group died due to postoperative rebleeding. CONCLUSIONS: IPAs are prevalent among all pediatric intracranial aneurysms, and head trauma is the most important risk factor. IPAs present with more intracerebral hematomas, tend to be larger, and are commonly observed in the ICA, MCA, and distal arterial location; they also carry a high risk of seizures. Both surgical and endovascular treatment could achieve favorable clinical outcomes, but more studies are needed to reveal which treatment approaches are best suited for pediatric IPAs.