Pediatric Giant Aneurysms: Experience at the Barrow Neurological Institute

Introduction: Giant aneurysms have been reported to occur at a higher incidence in pediatric patients than in adult patients. However, there is limited knowledge about their epidemiological patterns and outcomes after treatment. In our study, we sought to analyze pediatric giant aneurysms to gain insight into common locations, clinical presentation, and morphological characteristics, as well as the efficacy and safety of treatment options.

Methods: 13 pediatric patients (≤18yrs) presenting with giant aneurysms (≥25mm) managed at the Barrow Neurological Institute from 1991 to 2022 were studied. Demographics, presenting symptoms, operative approach, procedural information, outcomes, and complications were analyzed.

Results: The mean size was 36.9mm, ranging from 25 to 100mm. There were six (46.2%) saccular aneurysms, five (38.5%) fusiform aneurysms, one (7.7%) dissecting aneurysm, and one aneurysm with unknown morphology. Four (30.8%) were located in the posterior circulation, with the remaining nine (69.2%) in the anterior circulation. Six (46.1%) patients presented with subarachnoid hemorrhage, with an average Hunt-Hess grade of 2.8. Twelve patients were treated with open surgery, and one patient was treated endovascularly. In patients who underwent open repair, six (50.0%) were treated with clip reconstruction, and six (50.0%) were treated with bypass surgery. Of those who underwent open repair, two (16.7%) patients required additional procedures. The patient who underwent endovascular repair was originally treated with coil embolization and was later treated with balloon-assisted coil embolization after residual aneurysm was found. No mortalities were observed in any of the 13 patients.

Conclusion : Pediatric patients had giant aneurysms most commonly located in the anterior circulation. Outcomes were similar to reported outcomes for giant aneurysms in adults, but there was a lower rate of mortality in those treated with open repair than in the literature.