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  • Pediatric Intracranial Aneurysms: Transition of a Unit into Endovascular Management

    Final Number:
    547

    Authors:
    Andile Lungani Mbatha MBChB; Motebejane Samson; Duncan Royston; Yusentha Balakrishna; Rohen R. Harrichandparsad MBCHB, Fellowship Neurosurgery

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Intracranial aneurysms are rare in the paediatrics (= 18 Years). The reported prevalence is 0.5 – 4.6%. We report on the presentation, aetiology, management and outcomes of patients managed at our institutions in a period of transition into endovascular management.

    Methods: Retrospective review of medical records of patients treated from January 2003 to February 2016. Data was analysed for demographics, clinical presentation, Glasgow Coma Scale (GCS), radiological features, management and outcomes

    Results: Twenty three patients, with a total of thirty one aneurysms were recruited. Mean age was 12.4 ± [4.5]. Nine patient were tested for HIV, three positive, one had CD4 <200. Mean GCS was 13.2 ± [2.9] with headache and hemiparesis, the most common symptoms. The commonest cranial nerve palsy were third [7, 30%] and seventh [4, 17%]. Radiologically findings showed subarachnoid haemorrhage [11, 48%], infarcts [4, 17%], intracerebral haematoma [8, 35%], hydrocephalus [4, 17%]. FISCHER Grade: Four [3, 13%], Three [7, 30%], One [3, 13%]. Post traumatic were [4, 17%] and unruptured [6, 26%]. Diagnostic investigations were CT cerebral angiogram (CTA) [12, 52%], MRI angiogram [6, 26%], Digital subtraction angiogram [5, 22%]. Aneurysm location was 20 (65%) anterior and 11(35%) posterior circulation. Mean aneurysm size was 8.2mm± [0.44]. Morphology was fusiform (14, 45%), saccular (13, 42%), dissection (1, 3%), pseudo-aneurysm (3, 10%). Aetiology showed infective [5, 22%], unknown [11, 48%], traumatic [4, 17%], vasculitis [3, 13%]. Ten (47%) were managed medically, four (17%) microsurgery, nine (39%) endovascular. Mortality was 2(9%) one in hospital, associated with re-bleed, one at one month discharge. Mean GCS at discharge was13.6±3.3, mean hospital stay 20.8±12.7 and median Glasgow Outcome Score (GOS) of 17 patients followed up was (GOS5) 12 months.

    Conclusions: Paediatric aneurysms in our review have a predominance of fusiform type, unidentified cause, present good grade and have good outcomes

    Patient Care: This will aid in the referral management and work up of patients tretaed at our institute and referral institutions.

    Learning Objectives: Outcomes of treatment in paediatric aneurysms

    References:

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