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  • TRAUMATIC PERICALLOSAL ANEURYSM IN A 7-YEAR OLD CHILD: A CASE REPORT

    Final Number:
    136

    Authors:
    Hector T Rondon MD; Joel Enrique Pellot-Cestero; Rafael Rodriguez-Mercado MD, FACS; Caleb Feliciano-Vals MD

    Study Design:
    Clinical trial

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: Intracranial aneurysm in children is a rare pathology, accounting for merely 0.5-4.6% of all cerebral aneurysms. This pathology are characterized by predominance in male subjects, larger size and a prevalent distal localization. Traumatic intracranial aneurysms are occurring in fewer than 1% of patients,they can occur following blunt or penetrating head trauma. The most common location of such lesions in children is the pericallosal or adjacent branch of the anterior cerebral artery, where a head impact exerts sudden decelerating shearing forces on the arteries tethered on the brain surface against an immobile falx cerebri, weakening the arterial wall

    Methods: Review of case of a 6-year-old male patient, that suffered a motor vehicle accident without any neurological sequel at that time. Three weeks later, the patient present a hard headache with a right frontoparietal distribution and altered mental status. The patient was transferred to the ER, a CT was ordered and a left frontoparietal acute subdural hematoma was found. Surgical arrangements were done for a left frontoparietal craniectomy with evacuation of hematoma. The patient was kept under neurological observation for 3 days and was discharged home neurologically stable at that time. One day later, the patient had a clonic tonic seizure episode with neurological deterioration, a CT with evidence of diffuse cerebral edema was performed and a contralateral craniectomy was indicated. Postoperative CT angiography was ordered, observing a right pericallosal aneurysm, for which a digital subtraction angiography (DSA) was indicated

    Results: Endovascular treatment of the aneurysm was planned which was performed under general anesthesia. Initially, a 5F sheath was placed into the left Femoral artery. A 5F Support Catheter was placed coaxially within the cervical segment of left ICA and subsequently a Micro-catheter was delivered into the aneurysmal sac measure 11.5×7.3mm, using 6 different featured and sized detachable coils. A successful embolization was achieved without remaining flow to the aneurysm and appropriate measures for increased intracranial pressure were taken

    Conclusions: Surgical craniotomy for traumatic intracranial aneurysm is a high-risk operation.Advancements in minimally invasive technology have allowed for endovascular reconstruction of traumatic aneurysm, reducing the surgical risk evidenced by good clinical evolution in the patients treated

    Patient Care: Knowledge about the possibility of evidence of post-traumatic brain aneurysms in pediatric patients and discussion of cases for decision making in the treatment of pathology

    Learning Objectives: Intracranial traumatic aneurysms in children are a rares and is associated with high rates of morbidity and mortality, we describe our experience with this case report

    References:

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