Microsurgical Treatment of a Giant Intracavernous Carotid Artery Aneurysm in a Pediatric Patient. Case Report and Literature Review

Introduction: Intracranial aneurysms in pediatric age represent 4 - 5% of all cases, and 20% are giant (>25mm). The main sites of occurrence are ICA and MCA; about 55% - 72.5% of cases present rupture and secondary SAH with a 10% - 23% mortality. Case Description: We report the case of a previously healthy nine-year-old woman that initiated severe right retroocular pain and holocraneal headache. Her relatives detected paresis of the III, IV, and VI cranial nerves three days later. After evaluation, an MRI showed the presence of a giant aneurysm in the cavernous portion of the internal carotid artery (ICA) with a mass effect. The patient was treated surgically through a high-flow bypass using a radial artery graft and trapping of the aneurysm. The patient had an uneventful postoperative course and was discharged three days after the operation to continue in follow-up at the outpatient clinic. Discussion: The options for treatment are endovascular treatment through flow diverters or stenting and coiling, with the risk of incomplete occlusion or thrombosis. On the other hand, the goal of surgery is the permanent occlusion through the proximal closure of the ICA if a balloon occlusion test shows good collateral circulation or by trapping the aneurysm combined with a high-flow bypass if the collateral circulation is not good or absent. Conclusion: Even when the surgical option was successful in this case, there is no consensus about the best treatment; the selection of the method to use in these aneurysms depends on the center´s experience when confronting this rare entity.