Surgical Management of Aneurysms in the Pediatric Age Group

This chapter discusses the surgical management of aneurysms in the pediatric age groups. The most common aneurysm site in pediatrics is the internal carotid artery bifurcation. There is a change in the pathology in children under 2 to 5 years old. The most common locations become the middle cerebral artery and the basilar artery bifurcation. Middle cerebral aneurysms are equally distributed between proximal and distal sites, the latter by contrast being very uncommon in adults. Most aneurysms in children are saccular aneurysms. These are likely acquired through hemodynamically induced degeneration of the internal elastic membrane at arterial bifurcations. Defects in the tunica media are much more common than aneurysms and probably do not directly contribute to aneurysm formation. It is likely that factors such as clinical grade, amount of subarachnoid blood on computed tomographic scan, day of admission after hemorrhage, and associated intracerebral and intraventricular hemorrhage that are important in adults are also important in children. Aneurysm site and size, hypertension, and associated medical illnesses were prognostic factors for outcome in multivariate analysis in adults but may be less important in pediatrics.