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Endovascular treatment of pediatric basilar artery aneurysms: case series and literature review

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Abstract

Purpose

Pediatric basilar artery aneurysms are rare and challenging to treat. Microsurgical options and standard endovascular coiling are often undesirable choices for treatment of this pathology. Additional endovascular strategies are needed.

Methods

Presentation, diagnosis, and management of pediatric basilar aneurysms were reviewed, with an emphasis on endovascular treatment strategies. Our case series of 2 patients was presented in detail, one treated with flow diversion and vessel sacrifice and one treated with stent-assisted coiling. An extensive review of the literation was performed to find other examples of pediatric basilar artery aneurysms treated with endovascular techniques.

Results

Twenty-nine studies met inclusion criteria. Fifty-nine aneurysms in 58 patients were treated using endovascular techniques. Mortality rate was 10.3% (6/58) and a poor outcome (GOS 1–3) occurred in 15.5% (9/58). There were 4 reported recurrences requiring retreatment; however, only 46.5% of patients had reported follow-up of at least 1 year. 71.1% (42/59) were dissecting aneurysms.

Conclusion

Basilar artery aneurysms in the pediatric population are rare, commonly giant and fusiform, and often not amenable to microsurgical or coiling techniques. The surrounding vasculature, location, size, and morphology of the aneurysm along with the durability of treatment must be considered in treatment decisions. With proper patient selection, stent-assisted coiling and flow diversion may increase the durability and safety of endovascular treatment in this population.

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Availability of data and material

Data and materials are available upon request.

Abbreviations

PED:

Pipeline embolization device

PCA:

Posterior cerebral artery

AICA:

Anterior inferior cerebellar artery

PICA:

Posterior inferior cerebellar artery

VA:

Vertebral artery

PCoA:

Posterior communicating artery

SCA:

Superior cerebellar artery

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Author information

Authors and Affiliations

  1. Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA

    David R. Peters, Jonathan M. Parish, William R. Stetler, Scott D. Wait & Joe D. Bernard

  2. Department of Neurosurgery, Atrium Health, Charlotte, NC, USA

    David R. Peters, Jonathan M. Parish, William R. Stetler, Scott D. Wait & Joe D. Bernard

  3. Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland

    David R. Peters, Daniele Starnoni & Lorenzo Giammattei

Authors
  1. David R. Peters
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  2. Jonathan M. Parish
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  3. Daniele Starnoni
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  4. Lorenzo Giammattei
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  5. William R. Stetler
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  6. Scott D. Wait
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  7. Joe D. Bernard
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Contributions

David Peters—writing of the manuscript, literature review, preparation of figures. Jonathan Parish, Daniele Starnoni, Lorenzo Giammattei—literature review, critically revising the paper. William Stetler, Scott Wait—design and supervision of the paper, critically revising the paper. Joe Bernard—design and supervision of the paper, critically revising the paper, clinical management of patients presented.

Corresponding author

Correspondence to David R. Peters.

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Ethics approval and consent to participate

This retrospective chart review involving two human patients was under the ethical standards established by the 1964 Helsinki Declaration. Institutional review board (IRB) approval at Atrium Health Carolinas Medical Center hospital was obtained. Written informed consent by the patients was deemed not applicable since there was no information of the participants in the manuscript that compromise anonymity.

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All authors consent that this manuscript should be published in Child’s Nervous System.

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I declare that the authors have no competing interests or other interests that could be perceived to influence the results or discussion of this manuscript. None of the authors has any disclosures or conflicts of interest.

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Peters, D.R., Parish, J.M., Starnoni, D. et al. Endovascular treatment of pediatric basilar artery aneurysms: case series and literature review. Childs Nerv Syst 39, 25–34 (2023). https://doi.org/10.1007/s00381-022-05728-9

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