Based on his young age and wide-neck morphology, surgical exploration and microsurgical clipping of this aneurysm were successfully performed by pediatric neurosurgeon John A. Grant, M.D., to prevent life-threatening recurrent hemorrhage. Angiograms immediately the following clipping and at 6 months (Figure 2) confirms complete exclusion of the aneurysm.
He has made a full recovery and has returned to school and all activities.
Figure 1: A) NCT diffuse SAH with mild hydrocephalous B) DSA of “blister” aneurysm right ICA Terminus C) 3D DSA of aneurysm
Figure 2: Post Clip DSA A) Immediate Post Op and B) at 6 months
KEY LEARNING POINTS:
A 9-year-old boy with a history of chronic, intermittent headaches suddenly collapsed while on a school trip.
An initial CT of the brain revealed an extensive subarachnoid hemorrhage (SAH), with mild hydrocephalous. He underwent temporary endoventricular drainage and a cerebral angiogram (Figure 1) which demonstrated a small “blister” aneurysm or dissection of the Right Internal Carotid Artery(ICA) terminus.