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Posttraumatic cerebrovascular injuries in children. A systematic review

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Abstract

Introduction

Posttraumatic craniocervical vascular injuries in pediatric traumatic brain injury (TBI) are rare, and children-specific, evidence-based standards on screening and therapy of posttraumatic carotid-cavernous fistula (CCF), craniocervical artery dissections (CCAD), traumatic aneurysms (TA), and posttraumatic sinus venous thrombosis (SVT) is lacking. The aim of this review is to summarize the data on epidemiology, clinical presentation, and treatment of these traumatic lesions in a systematic manner.

Methods

We performed a systematic PubMed search for records of CCF, CCAD, TA, and SVT related to pediatric TBI published until June 2019.

Results

After screening 2439 records, 42 were included in the quantitative analysis. Incidences for CCAD in blunt TBI were 0.21% (range 0.02–6.82%). 11.7% (range 1.69–15.58%) of pediatric aneurysms were found to be traumatic of origin, whereas 38.2% (range 36.84–40%) of all pediatric SVT were due to blunt TBI. For all of the posttraumatic cerebrovascular pathologies, we found a clear male predominance with 68.75% in CCF, 63.4% in CCAD, 60% in TA, and 58.33% in SVT. Clinical presentation did not differ from the adult population with exception of young child. While there is only recommendation for the therapy of CCAD and SVT in the pediatric population, no such recommendation exists for the treatment of CCF’s and TA’s, and data from randomized controlled trials is lacking.

Conclusion

While these results show that posttraumatic CCF, CCAD, TA, and SVT are rarely encountered in children, misdiagnosis may have potentially drastic consequences due to a longer lifetime burden in the pediatric population. Awareness, early recognition, and prompt initiation of the appropriate therapy are essential to avoid morbidity and mortality. Further studies should focus on the development of clinical and radiological screening criteria of posttraumatic vascular lesions in children.

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Abbreviations

AHA:

American Heart Association

AP:

Antiplatelet

AC:

Anticoagulation

ASA:

Acetylsalicylate acid

BCVI:

Blunt cerebrovascular injury

CCAD:

Craniocervical artery dissection

CCF:

Carotid-cavernous fistula

CT:

Computed tomography

CTV:

CT venogram

GCS:

Glasgow Coma Scale score

MRI:

Magnetic resonance imaging

MRA:

Magnetic resonance angiography

PA:

Pseudoaneurysm

IA:

Intracranial aneurysm

ICH:

Intracerebral hemorrhage

ICA:

Internal carotid artery

SVT:

Sinus venous thrombosis

TA:

Traumatic aneurysm

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Nader Hejrati, Florian Ebel, Raphael Guzman & Jehuda Soleman

  2. Division of Pediatric Neurosurgery, University Children’s Hospital of Basel, Spitalstrasse 33, Basel, 4056, Switzerland

    Raphael Guzman & Jehuda Soleman

  3. Faculty of Medicine, University of Basel, Basel, Switzerland

    Raphael Guzman & Jehuda Soleman

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Hejrati, N., Ebel, F., Guzman, R. et al. Posttraumatic cerebrovascular injuries in children. A systematic review. Childs Nerv Syst 36, 251–262 (2020). https://doi.org/10.1007/s00381-019-04482-9

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