1206. Ruptured Giant Middle Cerebral Artery Aneurysm in an 11-week-old Infant: Case Report and Literature Review

Authors: Vadim V. Gospodarev; Lydia Kore, BS; Annie Wang, MD; Timothy Eastin, MD; Brett Kaplan, MD; Jeremy Deisch, MD; Ramachandran Pillai (Carlsbad, CA)

Introduction: In comparison to adult aneurysms, pediatric aneurysms vary in location, gender, and etiology.Here we report a case of a ruptured aneurysm in an 11-week old male infant, highlighting the importance of early recognition and imaging, as well as emphasizing challenges in management with respect to age, anesthesia and surgical intervention. Methods: A non-contrast computerized tomography scan of the head revealed a hyperdense mass in the inferior left frontal lobe/subinsular region that was measured to be 2.9 cm x 3 cm x 1.6 cm (Anterior-Posterior x Transverse x Cranial-Caudal) with surrounding cerebral edema.Differentials for the underlying cause of suspected intraparenchymal hematoma included vascular malformation, neoplasm or a cerebral aneurysm. The patient was placed in the supine position for a left frontotemporal craniotomy, which allowed for maximal visualization of the intracranial lesion. The patient underwent a craniotomy for resection of the aneurysm, evacuation of the associated blood clot and placement of an external ventricular drain. Results: On a follow up visit, 1 month after discharge, the patient was doing well with no new seizures, fevers, vomiting or increased lethargy. There were no signs of infection at the surgical site, which had healed well with no complications. Conclusion: Neonatal intracranial aneurysms are exceedingly rare and complex lesions that are infrequently reported.Neonates with intracranial aneurysms possess unique characteristics that are different from adults, in regard to location, morphology, etiology, presentation, and management. Understanding the cerebral anatomy, pathophysiology, age-dependent variables, perioperative effects of surgery and anesthesia are of utmost importance when caring for pediatric neurosurgical patients in order to minimize morbidity and mortality in this fragile patient population.