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  • Extracranial to Intracranial Bypass for the Treatment of Cerebral Aneurysms in the Pediatric Population; a Case Report and Review of the Literature

    Final Number:

    Ben Allen Strickland MD; Frank Attenello MD; Jonathan Russin MD

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction: Cerebral aneurysms are rare in the pediatric population, making a definitive treatment algorithm difficult. Microsurgical clipping is the first choice for treatment, though it has its disadvantages. Extracranial-intracranial (EC-IC) bypass, though not commonly performed in the pediatric aneurysm population, has been reported in a small number of studies to be both safe and effective for the management of cerebral aneurysms.

    Methods: The authors present an illustrative case of a child with a distal middle cerebral artery (MCA) aneurysm in eloquent territory successfully treated with a superficial temporal artery (STA) to MCA bypass and trapping and review all literature on pediatric EC-IC bypass in the treatment of intracranial aneurysms.

    Results: The pediatric population poses unique challenges, including small vessel diameter, graft considerations such as size and long-term impact of graft harvest, future growth of the patient, and longer expected lifetimes. Seven reports totaling 43 EC-IC bypass cases have been reported, in addition to our patient with a successful EC-IC bypass for a giant aneurysm. A conservative assessment of the best available literature dictates that EC-IC bypass for aneurysms in the pediatric population can achieve aneurysm obliteration in 90% or greater of the cases with a long-term complication rate of less than 10%. When considering that a greater proportion of these aneurysms are giant or fusiform these outcomes are equal to or superior to those achieved in the adult population.

    Conclusions: Though the majority of reported EC-IC bypasses for aneurysms in the pediatric population have demonstrated to be safe and effective, there still remains a relatively small number of cases performed overall, and most of these cases have relatively short-term follow up data. Further analysis with longer follow up periods is warranted. However, the outcomes reported in the above review suggest that EC-IC bypass can provide a therapeutic benefit for a select pediatric aneurysm population.

    Patient Care: By demonstrating that, though rarely performed in the pediatric aneurysm population, EC-IC bypass can be done both safely and effectively.

    Learning Objectives: By conclusion of this session, participants should be able to: 1) Understand Extracranial-Intracranial bypass can be performed safely and effectively in a select pediatric aneurysm population

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