Journal article
Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging
World neurosurgery, v 109, pp 418-431
01 Jan 2018
PMID: 28986225
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking.
METHODS: We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience.
RESULTS: Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping.
CONCLUSIONS: We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
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Details
- Title
- Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging
- Creators
- Michael George Zaki Ghali - Baylor College of MedicineVisish M. Srinivasan - Baylor Coll Med, Dept Neurosurg, Houston, TX 77030 USAJacob Cherian - Baylor College of MedicineLouis Kim - University of WashingtonAdnan Siddiqui - Buffalo State CollegeM. Ali Aziz-Sultan - Harvard University ,Michael Froehler - Vanderbilt UniversityAjay Wakhloo - University of Massachusetts Medical SchoolEric Sauvageau - Baptist Neurological InstituteAnsaar Rai - West Virginia UniversityStephen R. Chen - Baylor College of MedicineJeremiah Johnson - Baylor College of MedicineSandi K. Lam - Baylor College of MedicinePeter Kan - Baylor College of Medicine
- Publication Details
- World neurosurgery, v 109, pp 418-431
- Publisher
- Elsevier
- Number of pages
- 14
- Resource Type
- Journal article
- Language
- English
- Web of Science ID
- WOS:000419015000182
- Scopus ID
- 2-s2.0-85034016711
- Other Identifier
- 991019312470304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery