Stent-assisted coil embolization for a pediatric distal posterior cerebral artery aneurysm: A case report and review

Pediatric intracranial aneurysms (PIAs) are uncommon and account for less than 5% of all cerebral aneurysms, and 3.1% of PIAs are located in the posterior cerebral artery (PCA). To the best of our knowledge, only a few cases of pediatric PCA unruptured aneurysms have been reported to date. The authors herein report our recent experience of treating a pediatric symptomatic distal PCA unruptured aneurysm by the stent-assisted coiling. A 12-year-old boy presented to a neurosurgery clinic with the recurrent headaches but showed no neurologic deficits. Magnetic resonance imaging (MRI) revealed a large left distal PCA unruptured aneurysm. Although he had a trauma history of two-time head impacts at 4 and 7 years of age, the etiology of the aneurysm was not clear. Since the patient had no neurologic deficits and did not want to take surgery, he had been followed-up on an outpatient basis first. However, as the aneurysm showed enlargement at 16 months, the patient and his parents decided to take an endovascular surgery. Dual antiplatelet therapy (DAPT) was initiated a week before the surgery. A stent-assisted coil embolization of the aneurysm was successfully performed under general anesthesia. The patient had persistent headaches but was discharged home without any neurologic deficits. The patient has been followed up for 19 months after the surgery, but neither complications nor aneurysm recanalization has been presented. Endovascular intervention could be the mainstay of treatment for the pediatric aneurysm that shows interval growth.