Alternate Therapies for Intracranial Aneurysms in Children

Endovascular Treatment

• Status quo: In a review of the literature on pediatric intracranial aneurysms published after 2000, the author found endovascular treatment in 35% of pediatric aneurysm cases, including the application of stent-assisted procedures and flow diverters (8).
• Clinical evidence: No randomized controlled trials comparing treatment options in pediatric aneurysms are published. However, single center series indicate good results (3).
• Generalization from adult data: The International Subarachnoid Aneurysm Trial (ISAT) compared endovascular coiling to surgical clipping in ruptured aneurysms in adults in a prospective randomized fashion (50). The main finding was that the risk of dependency or death at 1 year was significantly lower in the endovascular group. Of note, the late rebleeding rate was 0.21% per patient-year in the endovascular group compared to 0.063% in the surgical group (49). The observation that an increased risk of recurrent bleeding might exist from a coiled aneurysm is important when planning the treatment of a child, considering the longer life expectancy (58). Careful follow-up thus is recommended.
• Parental preference: When discussing treatment strategies for children, a parental bias toward nonoperative treatment has been reported (58).