History of Management of Intracranial Aneurysms in Children Understanding of Disease

Understanding of Disease

• First case reports in the 19th century: Eppinger reported on children suffering aneurysmrupture during exercise, confirmed by post-mortem examination. He also discussed the etiology of pediatric aneurysms and suggested an association with aortic coarctation (16).
• Larger series in the 20th century: In 1965 Matson published a series of 14 pediatric aneurysms. He noted that incidental aneurysms were not found on autopsy or angiography in children. This report also showed that surgical treatment is feasible and outcome is better when compared to adults (46). In 1966 Locksley and colleagues published the results of the Cooperative Study on Intracranial Aneurysms and Subarachnoid Hemorrhage, which comprised more than 6,000 cases. Only 4% of patients with ruptured aneurysms were younger than 20 years (43, 44).

Technological Development

• Imaging technology: The continuous refinement of CT, MRI, and catheter-based DSA techniques has allowed for improved diagnostic evaluation and contributed significantly to the scientific body of knowledge regarding common locations and configurations (1).
• Surgical technique: The advent of microsurgery in general and the development of instruments and clips for cerebrovascular microsurgery has had a lasting effect on treatment of pediatric aneurysms, although no tools or clips were designed specifically for children (10). Moreover, less common techniques including aneurysm trapping, cerebrovascular bypass, and hypothermic cardiac arrest have been described in children (35).
• Endovascular technique: Coiling and, more recently, stents and flow diverters have been applied in children (5, 39).

Surgical and Endovascular Technique

• Surgical and microsurgical clipping: The first successful clipping of an intracranial aneurysm is attributed to Dandy (13). Clips and instruments were modified by various neurosurgeons in the following decades (47, 65). Microsurgical techniques were propagated by Yaşargil (65).
• Endovascular treatment of intracranial aneurysms: Guglielmi established the use of detachable coils for endovascular obliteration of intracranial aneurysms (25).