Management of Pediatric Posterior Circulation Aneurysms-12-Year Single-Institution Experience

Background: Pediatric posterior circulation aneurysms are rare, complex, poorly understood lesions on which only limited literature is currently available. We report our 12-year experience of managing this condition to enhance knowledge of this rare entity.

Methods: Patients <18 years old with posterior circulation aneurysms managed at our institution from January 2005 to April 2017 were included. Demographic, clinical, radiologic and management details were retrieved from hospital records and characteristics of the aneurysms and treatment were analyzed.

Results: During this period, 20 pediatric patients (male-to-female ratio 15:6; mean age, 13.1 years) with posterior circulation aneurysms were treated. Most of the patients (75%) presented with subarachnoid hemorrhage. The most common location was the vertebrobasilar junction and vertebral artery (31.81%) followed by the basilar artery and the posterior cerebral artery (27.72% each). Dissecting (81.8%) and large (63.63%) aneurysms were the most common types noted. Of the15 patients with 22 aneurysms treated, 13 underwent endovascular management (parent vessel sacrifice in 8 aneurysms and parent vessel preservation in 5 aneurysms), 1 patient underwent surgery, and 1 patient received medical management for central nervous system tuberculosis. During follow-up, 1 patient had recurrence of aneurysm, and 1 patient died after discharge from the hospital. Overall good outcome was recorded in 90% of patients (Glasgow Outcome Scale score 4-5).

Conclusions: Vertebrobasilar junction and vertebral artery was the most common location for posterior circulation aneurysms and most were dissecting aneurysms. Endovascular treatment was the mainstay of management. Overall good outcome was observed at long-term follow-up.