- Establish an evidence base for treatment of pediatric aneurysms: Prospective studies/registries or randomized controlled trials would help determine which treatment modalities are most effective in children. Long-term durability of treatment and long-term outcome should be important aspects in such endeavors. Of particular interest is the safety and efficacy of more recently developed devices such as flow diverters and intrasaccular flow disruptors (134).
- Investigate the pathophysiology of pediatric aneurysms: The historical hypothesis of cerebral aneurysms being congenital lesions has not been supported by existing data (135). Modern studies suggest that intracranial aneurysms are indeed undergoing permanent structural changes and are influenced by a variety of factors, such as inflammation, hemodynamic stress, remodeling, and genetic predisposition (136). However, the vast majority of epidemiological, clinical, and laboratory studies in this field focus only on adults. Since pediatric aneurysms represent a distinct entity in many respects, pediatric studies are necessary to explore their pathogenesis. As these lesions are rare, multicenter studies or national/international registries might be helpful.
- Drug therapies: Recently, authors have advocated for the investigation of pharmaceutical approaches to the prevention of aneurysm growth and/or rupture (137–139).
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