Complications of Therapies for Intracranial Aneurysms in Children

Total treatment-related morbidity is encountered in 20% to 25% of cases, although this ranges from minimal to significant severity. The surgical mortality rate is significantly less than 5% in most series (9,101).

Surgical

Intraoperative complications

• Re-rupture of the aneurysm: In a series of 53 surgical procedures, intraoperative re-rupture occurred in two children; both cases were managed successfully (101). This is not dissimilar to surgical treatment of ruptured aneurysms in adults, where dissection of the neck for clipping can be associated with rupture.

Postoperative complications

• Hematoma: In a series of 53 surgical procedures, a postoperative intracranial hematoma occurred in two children (101).
• Permanent and transient neurological deficits: In the same series, a permanent neurological deficit was observed in three children (101). Postoperative infarction and transient neurological deficits may also be observed (7). The rate of postoperative stroke after surgical clipping is slightly more than 3% (125).
• Hydrocephalus: In the same series, two children required the placement of a ventriculoperitoneal shunt (101).
• Infection: Although no data are published specifically on postoperative infections after pediatric aneurysm surgery, an infection rate after craniotomy of about 0.5% can be expected. The most common bacteria are Staphylococcus aureus and gram-negative rods (126).

Medical

• None: There are no accepted medical treatments for intracranial aneurysms in children.

Other Therapies

Endovascular

• Intraprocedural rupture: Re-rupture during endovascular aneurysm repair has been reported (12).
• Permanent complications: The rate of permanent procedural complications has been reported to be between 3.3% and 6.7% (62).
• Transient neurological deficits: Postprocedural transient neurological deficits have been reported (7,62).
• Thromboembolic distal vessel occlusion: In a series of 32 children with cerebral aneurysms, embolization with either off-target embolisate or thrombus occurred in three cases (12).