Endovascular Reconstruction of Intracranial Aneurysms with the Pipeline Embolization Device in Pediatric Patients: A Single-Center Series

Peyman Shirani; Saeedeh Mirbagheri; Maksim Shapiro; Eytan Raz; Ashkan Mowla; Bita Semsarieh; Howard A Riina; Peter K Nelson

doi:10.1159/000496291

Endovascular Reconstruction of Intracranial Aneurysms with the Pipeline Embolization Device in Pediatric Patients: A Single-Center Series

Interv Neurol. 2020 Jan;8(2-6):101-108. doi: 10.1159/000496291. Epub 2019 Feb 15.

Authors

Peyman Shirani¹, Saeedeh Mirbagheri², Maksim Shapiro³, Eytan Raz³, Ashkan Mowla⁴, Bita Semsarieh¹, Howard A Riina³, Peter K Nelson³

Affiliations

¹ Department of Neurology/Rehabilitation Medicine and Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
² Department of Diagnostic Radiology, Mount Sinai Beth Israel Medical Center, New York, New York, USA.
³ Departments of Radiology and Neurology, Bernard and Irene Schwartz Neurointerventional Radiology Section, New York University School of Medicine, New York, New York, USA.
⁴ Department of Radiology, University of California, Los Angeles, California, USA.

Abstract

Background: Pediatric intracranial aneurysms tend to differ in etiology, size, and location from their adult counterparts, and they are often less amenable to microsurgical clip reconstruction techniques. Endovascular treatment with detachable coils is an accepted treatment technique for pediatric patients, though high recurrence rates have been reported with coil embolization of large and giant aneurysms in this population. While the Pipeline Embolization Device (PED) is FDA-approved for adult intracranial aneurysms, the use of PEDs in pediatric patients is considered off-label.

Case descriptions: We present 3 cases of pediatric intracranial aneurysms in a 5-year-old male, a 12-year-old male, and a 12-year-old female who presented with symptoms including seizure, headache, and blurred vision. The 2 male patients were found to have intradural vertebral artery saccular aneurysms, while the female patient had a paraophthalmic right internal carotid complex aneurysm. After endovascular reconstruction of the aneurysms with PEDs, follow-up angiography showed complete occlusion of the previous aneurysms with no residual aneurysm filling in all 3 cases.

Conclusion: While further investigation is needed, the evidence presented here supports the conclusion that the PED can be an effective and viable treatment strategy in the pediatric population.

Keywords: Endovascular coiling; Intracranial aneurysm; Pediatric population; Pipeline; Pipeline Embolization Device.