Pediatric intracranial aneurysms in Senegal: a series of 10 cases treated in unfavorable socio-economic conditions

The aim of this study is to show the characteristics of pediatric intracranial aneurysms in a sub-Saharan country and to analyze the results of treatment in this challenging medical environment. The authors reviewed retrospectively ten patients ≤ 18 years old between May 2013 and December 2016 in Neurosurgery department of Fann Hospital in Dakar. For each child, clinical features, radiological findings, and outcome were determined with mean follow-up of 22 months. Ten children were treated for intracranial aneurysm including four boys and six girls. Two patients had evolutive infectious endocarditis with rheumatic heart disease at the time of diagnosis. Neurological signs of deficiency were present in six patients (WFNS ≥ 3). The diagnosis of aneurysm was made by CT angiography in all patients, and in two of them respectively arteriography and angioMRI were performed in complement. The aneurysm was on the middle cerebral artery in six patients, on the internal carotid artery in two others, anterior communicating artery in another, and the last one was located on the anterior cerebral artery on its 3rd segment. The treatment of the aneurysm was surgical in seven patients and endovascular in one of them. The postoperative course was excellent in two patients and good in the five patients. No postoperative worsening was noted. One child died 4 months in the postoperative course from acute cardiac deterioration. In Senegal, pediatric aneurysms represent about 8.3% of all intracranial aneurysms. They are most often located on the MCA and have commonly fusiform shape. Despite difficult treatment conditions, overall outcome was good.