{
  "abstract": "Background and Purpose Data on etiologies, natural history, interventional approaches, and outcomes of pediatric intracranial arterial aneurysms is limited. We aimed to characterize the presentation and clinical course of patients with these lesions in our single-institution, tertiary hospital system.Materials and Methods We performed a retrospective medical record review of pediatric patients presenting between 2008 to 2024 and compared this cohort to our previously published, equivalent cohort from 1981 to 2008. We included intracranial arterial aneurysms identified on conventional cerebral angiograms at our hospital. We excluded aneurysms associated with AVMs (as intra- or peri-nidal), dAVFs, or VOG malformations.Results Preliminary analysis identified 54 patients with a total of 68 aneurysms. This cohort included 28 females (51.9%) and 26 males (48.1%). The average age of aneurysm presentation was 12 years old (range: 4 weeks to 17 years). Forty-four patients had a single aneurysm, while 10 patients had more than one aneurysm, either at first presentation or over time. Thirty-two patients (59.3%) presented with hemorrhage: bleeds were categorized mostly as subarachnoid hemorrhage (19 patients, 59.3%) sometimes associated with additional intraventricular hemorrhage, or intraparenchymal hemorrhage (8 patients, 25%). Twenty-two patients had no bleed at presentation though some experienced headache, altered mental status, nausea and emesis, and cranial neuropathies. Ten patients with aneurysms had known preceding trauma; of these, 7 developed a single traumatic aneurysm and 3 developed multiple. Systemic and intracranial infection resulted in 6 mycotic aneurysms. Other predisposing factors and comorbidities included: congenital cardiac pathology, vasculopathy (including moyamoya), positive family history, genetic VUS in RNF213, and systemic syndromes (including Goldenhar, McCune-Albright). Aneurysms developed on the right-sided arteries (47% cases), left-sided arteries (46%), and midline (7%). Aneurysms were found 74% in the anterior circulation (with most affected vessels, in order of occurrence, in MCA, ICA, ACA) and 26% in the posterior circulation (basilar artery, PCA, SCA). Morphology characterization revealed 19 fusiform, 5 saccular, 4 wide-necked, and 3 bilobed aneurysms. Interventional approaches to aneurysms included: 24 treated via open neurosurgical clipping and 21 endovascularly via embolization (15 with coiling, including GDC, Tetra, and DSC coils; 3 with ethanol chemoembolization; 1 with glue; 1 with Onyx) or a flow-diverter stent. Three aneurysms underwent unsuccessful coiling attempts prior to requiring neurosurgical treatment. Seven aneurysms were not intervened on and 2 had spontaneous thrombosis at time of planned intervention. Acute complications of aneurysmal-associated hemorrhage included hydrocephalus and vasospasm; long-term morbidity included chronic headaches and seizures. Compared with our previously published cohort (77 patients, 103 aneurysms), we confirmed female predominance and anterior circulation bias but observed more fusiform than saccular aneurysms and a higher hemorrhage rate (59% versus 32%).Conclusion Pediatric intracranial aneurysms carry high morbidity and mortality but can be effectively treated with endovascular and interventional approaches. Less is known about pediatric aneurysms than adult ones due to their rarity, though generally they are larger, linked to congenital, traumatic, or infectious causes, and carry higher lifetime rupture risk. Combined with our prior series, this study represents the largest single-institution pediatric intracranial arterial aneurysm cohort to date.Disclosures P. Deshpande: None. R. Vassar: None. C. Fox: None. H. Fullerton: None. N. Gupta: None. M. Amans: None. K. Narsinh: None. D. Cooke: None. E. Winkler: None. L. Savastano: None. D. Raper: None. S. Hetts: None.",
  "authors": [
    {
      "affiliations": [
        "Neurology and Pediatrics, UCSF, San Francisco, CA"
      ],
      "name": "P Deshpande"
    },
    {
      "affiliations": [
        "Neurology and Pediatrics, UCSF, San Francisco, CA"
      ],
      "name": "R Vassar"
    },
    {
      "affiliations": [
        "Neurology and Pediatrics, UCSF, San Francisco, CA"
      ],
      "name": "C Fox"
    },
    {
      "affiliations": [
        "Neurology and Pediatrics, UCSF, San Francisco, CA"
      ],
      "name": "H Fullerton"
    },
    {
      "affiliations": [
        "Neurological Surgery and Pediatrics, UCSF, San Francisco, CA"
      ],
      "name": "N Gupta"
    },
    {
      "affiliations": [
        "Radiology & Biomedical Imaging and Neuroendovascular Surgery, UCSF, San Francisco, CA"
      ],
      "name": "M Amans"
    },
    {
      "affiliations": [
        "Radiology & Biomedical Imaging and Neuroendovascular Surgery, UCSF, San Francisco, CA"
      ],
      "name": "K Narsinh"
    },
    {
      "affiliations": [
        "Radiology & Biomedical Imaging and Neuroendovascular Surgery, UCSF, San Francisco, CA"
      ],
      "name": "D Cooke"
    },
    {
      "affiliations": [
        "Neurological Surgery and Neuroendovascular Surgery, UCSF, San Francisco, CA"
      ],
      "name": "E Winkler"
    },
    {
      "affiliations": [
        "Neurological Surgery and Neuroendovascular Surgery, UCSF, San Francisco, CA"
      ],
      "name": "L Savastano"
    },
    {
      "affiliations": [
        "Neurological Surgery and Neuroendovascular Surgery, UCSF, San Francisco, CA"
      ],
      "name": "D Raper"
    },
    {
      "affiliations": [
        "Radiology & Biomedical Imaging and Neuroendovascular Surgery, UCSF, San Francisco, CA"
      ],
      "name": "S Hetts"
    }
  ],
  "title": "E-171 Pediatric intracranial aneurysms: etiology, morphology, management, and long-term outcomes",
  "uid": "3c99e2b6-d505-560f-8a95-409d998105ae"
}