Pediatric intracranial aneurysm management: illustrative case

BACKGROUND: Pediatric aneurysms are rare and challenging to treat, and long-term prospective data comparing endovascular and microsurgical approaches are limited. The growing incidence of recurrent coiled aneurysms in children further complicates surgical decision-making. OBSERVATIONS: A literature review of the PubMed and Cochrane Central databases (January 2000-December 2022) identified 32 studies encompassing 868 pediatric patients with intracranial aneurysms. Of these patients, 334 underwent endovascular treatment, 410 underwent microsurgical treatment, and the remainder were managed conservatively. Reinterventions were required in 22 endovascularly treated patients and 9 surgically treated patients. Among the 22 patients with endovascular reintervention, 12 ultimately transitioned to microsurgical management, with the rest receiving additional endovascular therapy. The authors describe a representative case of an adolescent with a ruptured internal carotid terminus aneurysm who required microsurgical rescue clipping after initial coil embolization. LESSONS: Management of ruptured pediatric aneurysms warrants distinct consideration and lacks consensus because of scarce long-term prospective evidence. Given children's extended life expectancy, treatment strategies should prioritize high obliteration and low recurrence rates, tailoring modality selection to minimize delayed flow insufficiency and the need for retreatment. https://thejns.org/doi/10.3171/CASE26681.