Role of Endovascular Treatment in Pediatric Cerebral Aneurysms: A Series of Two Case Reports
An 8-year-old female child presented with a complaint of persistent headache for 7 days (Grade I sub-arachnoid hemorrhage (SAH) (Hunt and Hess scale)). On clinical examination, there was no neurological deficit. Computerized tomography (CT) scan revealed Fischer Grade-3 SAH in the prepontine cistern and right sylvian fissure. Pre-procedure routine detailed work was done along with special investigations including antineutrophilic antibody (ANA), antineutrophilic cytoplasmic antibody (ANCA), and antiphospholipid antibody (APLA). Detailed screening and imaging were done to rule out any associated conditions, such as Autosomal dominant polycystic kidney disease (ADPKD), fibro muscular dysplasia, co-arctation of aorta, Ehlers syndrome, and Marfans syndrome.\nDigital Subtraction Angiography (DSA) showed the presence of A1saccular aneurysm on the right side [Figure ]. Endovascular treatment was planned after analyzing the morphology of the aneurysm and the flow hemodynamics of the aneurysm. The treatment was decided after discussion with the neurosurgeon and neurointensivist. High-risk informed consent was obtained from the parents after detailed explanation of the risks versus benefits of the treatment procedure.\nUnder general anesthesia, right 5F common femoral was accessed. Standard heparinization (100 units/kg as bolus at the beginning of the procedure followed by 20 units/kg every hour) was given to maintain the activated clotting time of 250 s. Guiding catheter (5F Envoy, cordis) with Nimodipine infusion was placed in the Internal Carotid Artery (ICA). Microcatheter (Echelon-10, eV3) over microwire (Expedion 14, eV3) was navigated into the sac of the aneurysm [Figure , , and ]. The aneurysm was densely packed with platinum coils. Post-procedure angiogram showed near total exclusion of the aneurysm from the circulation and excellent filling of all branches of the right ICA, anterior cerebral artery, and middle cerebral artery. Postprocedure, the patient was extubated in the cathlab and kept under observation for 3 days in the neurointensive care unit. There were no intra-, peri-, or post-procedural complications and the child was discharged on Day 7 post operation. Clinical follow-up after 1 month of the child showed absolutely normal results. Control angiogram done after 2 years showed stable occlusion of the aneurysm with coil mass in situ.