{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T20:42:48Z","timestamp":1771706568795,"version":"3.50.1"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Aneurysms are relatively rare in the pediatric population and tend to include a greater proportion of large and giant lesions. A subset of these large and giant aneurysms are not amenable to direct surgical clipping and require complex treatment strategies and revascularization techniques. There are limited data available on the management of these lesions in the pediatric population. This study was undertaken to evaluate the outcome of treatment of large and giant aneurysms that required microsurgical revascularization and vessel sacrifice in this population.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively identified all cases in which pediatric patients (age &lt; 18 years) with aneurysms were treated using cerebral revascularization in combination with other treatment modalities at their institution between 1989 and 2013.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The authors identified 27 consecutive patients (19 male and 8 female) with 29 aneurysms. The mean age of the patients at the time of treatment was 11.5 years (median 13 years, range 1\u201317 years). Five patients presented with subarachnoid hemorrhage, 11 with symptoms related to mass effect, 2 with stroke, and 3 with seizures; in 6 cases, the aneurysms were incidental findings. Aneurysms were located along the internal carotid artery (n = 7), posterior cerebral artery (PCA) (n = 2), anterior cerebral artery (n = 2), middle cerebral artery (MCA) (n = 14), basilar artery (n = 2), vertebral artery (n = 1), and at the vertebrobasilar junction (n = 1). Thirteen were giant aneurysms (45%). The majority of the aneurysms were fusiform (n = 19, 66%), followed by saccular (n = 10, 34%). Three cases were previously treated using microsurgery (n = 2) or an endovascular procedure (n = 1). A total of 28 revascularization procedures were performed, including superficial temporal artery (STA) to MCA (n = 6), STA to PCA (n = 1), occipital artery to PCA (n = 1), extracranial-intracranial (EC-IC) bypass using radial artery graft (n = 3), EC-IC using a saphenous vein graft (n = 7), STA onlay (n = 3), end-to-end anastomosis (n = 1), and in situ bypasses (n = 6). Perioperative stroke occurred in 4 patients, but only one remained dependent (Glasgow Outcome Scale [GOS] score 3). At a mean clinical follow-up of 46 months (median 14 months, range 1\u2013232 months), 26 patients had a good outcome (GOS score 4 or 5). There were no deaths. Five patients had documented occlusion of the bypass graft. The majority of aneurysms (n = 24) were obliterated at last follow-up. There was a single case of a residual aneurysm and one case of recurrence. Angiographic follow-up was unavailable in 3 cases.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Cerebral revascularization remains an essential tool in the treatment of complex cerebral aneurysms in children.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.3.peds13444","type":"journal-article","created":{"date-parts":[[2014,4,18]],"date-time":"2014-04-18T14:28:22Z","timestamp":1397831302000},"page":"641-646","source":"Crossref","is-referenced-by-count":40,"title":["Revascularization and pediatric aneurysm surgery"],"prefix":"10.3171","volume":"13","author":[{"given":"M. Yashar S.","family":"Kalani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali M.","family":"Elhadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wyatt","family":"Ramey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Nakaji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe C.","family":"Albuquerque","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron G.","family":"McDougall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph M.","family":"Zabramski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert F.","family":"Spetzler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-peds13444","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"365","DOI":"10.3171\/2012.8.PEDS12101","article-title":"High-flow bypass and tandem microsurgical-endovascular occlusion of recurrent proximal middle cerebral artery aneurysms in a pediatric patient. Case report","volume":"10","author":"Abla","year":"2012"},{"key":"b2-peds13444","series-title":"J Neurointerv Surg","doi-asserted-by":"publisher","first-page":"e47","DOI":"10.1136\/neurintsurg-2012-010478.rep","article-title":"Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter","volume":"5","author":"Burrows","year":"2013"},{"key":"b3-peds13444","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"79","DOI":"10.3171\/2011.4.PEDS10583","article-title":"Middle cerebral artery aneurysms in children: case series and review. Clinical article","volume":"8","author":"Fulkerson","year":"2011"},{"key":"b4-peds13444","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/s00381-008-0736-z","article-title":"Superficial temporal artery-middle cerebral artery bypass surgery in a pediatric giant intracranial aneurysm presenting as migraine-like episodes","volume":"25","author":"Goedee","year":"2009"},{"key":"b5-peds13444","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.3174\/ajnr.A1587","article-title":"Intracranial aneurysms in childhood: 27-year single-institution experience","volume":"30","author":"Hetts","year":"2009"},{"key":"b6-peds13444","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1227\/01.NEU.0000325497.79690.4C","article-title":"Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms","volume":"63","author":"Jahromi","year":"2008"},{"key":"b7-peds13444","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1161\/STROKEAHA.108.518761","article-title":"The importance of cerebral aneurysms in childhood hemorrhagic stroke: a population-based study","volume":"40","author":"Jordan","year":"2009"},{"key":"b8-peds13444","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1227\/01.NEU.0000371727.71991.64","article-title":"Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes","volume":"67","author":"Kakarla","year":"2010"},{"key":"b9-peds13444","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1227\/NEU.0b013e3182804381","article-title":"Extracranial-intracranial bypass and vessel occlusion for the treatment of unclippable giant middle cerebral artery aneurysms","volume":"72","author":"Kalani","year":"2013"},{"key":"b10-peds13444","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1227\/NEU.0b013e3182870703","article-title":"Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms","volume":"72","author":"Kalani","year":"2013"},{"key":"b11-peds13444","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"533","DOI":"10.3171\/2013.1.PEDS12444","article-title":"Pediatric bypasses for aneurysms and skull base tumors: short- and long-term outcomes. Clinical article","volume":"11","author":"Kim","year":"2013"},{"key":"b12-peds13444","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1227\/00006123-198907000-00014","article-title":"Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass","volume":"25","author":"Lansen","year":"1989"},{"key":"b13-peds13444","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.3171\/jns.1966.24.6.1034","article-title":"Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. 3. Subarachnoid hemorrhage unrelated to intracranial aneurysm and A-V malformation. A study of associated diseases and prognosis","volume":"24","author":"Locksley","year":"1966"},{"key":"b14-peds13444","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"420","DOI":"10.3171\/jns.1989.70.3.0420","article-title":"Cerebral aneurysms in childhood and adolescence","volume":"70","author":"Meyer","year":"1989"},{"key":"b15-peds13444","series-title":"Neurochirurgie","first-page":"243","article-title":"[Intracranial arterial aneurysm in children. A cooperative study. Apropos of 43 cases.]","volume":"34","author":"Roche","year":"1988"},{"key":"b16-peds13444","series-title":"Interv Neuroradiol","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1177\/159101991301900212","article-title":"Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report","volume":"19","author":"Shin","year":"2013"},{"key":"b17-peds13444","series-title":"Neurosurgery","first-page":"663","article-title":"Extracranial-intracranial vein graft bypass for giant intracranial aneurysm surgery for pediatric patients: two technical case reports","volume":"50","author":"Zhang","year":"2002"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/13\/6\/article-p641.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/13\/6\/article-p641.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/13\/6\/article-p641.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T14:18:18Z","timestamp":1681568298000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/13\/6\/article-p641.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,6]]},"references-count":17,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.3.peds13444","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,6]]}}}