Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents

42 cases concerning symptomatic intracranial circulation aneurysms and spontaneous SAH have been observed by the authors during the period 1965-1984; 37 of them were treated from 1970 on. This group represents 2.6% in the number of patients treated for SAH during the above mentioned period in the series of Pavia and Verona Neurosurgery. In 7 cases angiography did not evidence any malformation responsible for the hemorrhage. These cases have been defined as "sine materia" SAH. In 33 cases was documented the presence of an intracranial aneurysm as responsible for the hemorrhage. In the 2 remaining cases was found an aneurysm that even if unbroken had manifested itself. In 4 cases aneurysms were mycotic ones. The most frequent sites of aneurysms have been the carotid artery bifurcation and the middle cerebral artery 24% each one followed by the anterior communicating artery 21%. 5 patients were younger than 4 years and each one had peculiar clinical features. The 37 remaining patients were older than 9 years and have been subdivided in 2 groups: 16 patients from 9 to 15 years old in who the most common site of the aneurysm was the carotid artery bifurcation and the middle cerebral artery (31%) and the frequency of intracerebral hematoma was 50%; 21 patients from 16 to 20 years old in who the most common site of the aneurysm was the anterior communicating artery (33%) and the presence of an intracerebral hematoma was markedly inferior (14%). 23 of the 35 patients having an aneurysm underwent a surgical procedure for its exclusion. Operative mortality rate was nearly 5% and morbidity rate was nearly 12%. 5 patients who were in agony when admitted were not operated; 5 patients had a conservative therapy and in 2 of them an angiography performed at distance from the hemorrhage revealed the disappearance of the aneurysm. Clinical disturbances bound to ischemic phenomenons by cerebral vasospasm were observed in only 3 patients--all of them older than 17--in who a CT scan had showed a conspicuous cisternal blood suffusion. In 13% of cases appeared hydrocephalus and only in 3 cases was necessary to perform a shunt. The global results of therapy have been significantly better than in adults having 74% of good results and 19% of deaths. This prognostic improvement is probably due both to the well known recovery from neurological failure in young patients and to the very low incidence of ischemic manifestations from vasospasm in this range of age.