Repair process in spontaneous intradural dissecting aneurysms in children: report of eight patients and review of the literature

Objective  The objective of this study is to present a series of eight pediatric patients (less than 16 years old) with complete spontaneous thrombosis of spontaneous intradural dissecting aneurysms. Material and methods  Since 1989, eight consecutive patients in whom the cerebral aneurysms (four in middle cerebral arteries, one in posterior cerebral artery, three in basilar arteries) were found complete spontaneous thrombosis on follow-up MRI/MRA or conventional angiography. Patient histories and angiographic features were retrospectively reviewed. Results  Complete thrombosis of aneurysms in between first few days to 7 months was found in eight out of 1,587 patients (0.5%) in this recent series. Aneurysm repair was related to multivariate processes. Headache (50%), vomiting, and hemiplegia (37.5%) were common presenting symptoms. Partial or total resolution of the symptoms in a few months was often seen. Associated parent artery occlusions (50%) were also observed. Conclusion  Spontaneous resolution of intradural dissecting aneurysm with or without parent artery occlusion is not uncommon even in the pediatric population. Aneurysm repair is a dynamic and multifaceted entity. Mural hematoma appears to be the most important factor promoting thrombosis and healing of the dissecting intracranial aneurysms.