Flow diverters for intracranial aneurysm embolization with coil embolization in children with ruptured aneurysm: two cases reports.

Pediatric intracranial aneurysms are relatively rare and exhibit distinct characteristics compared with those in adults, particularly in terms of sex distribution, incidence, anatomical location, morphology, and underlying etiology. Notably, the risk of rupture and hemorrhage is substantially higher in the pediatric population. Among children younger than five years, approximately 85% of intracranial aneurysms initially present with rupture and bleeding, whereas this proportion decreases to 45% in those older than five years, still significantly exceeding the hemorrhagic risk observed in adults. Current standard treatment modalities for intracranial aneurysms include microsurgical clipping, stent-assisted coil embolization, and flow diverter implantation. However, there are relatively few reports on the use of flow diverters in pediatric patients, and the optimal antiplatelet regimen following endovascular treatment in this population remains controversial. In this study, we report two cases of ruptured giant intracranial aneurysms in children treated with flow diverter placement combined with dense coil embolization. One patient presented with a space-occupying intracerebral hematoma and subsequently developed intracranial hypertension with cerebral herniation after the procedure, necessitating decompressive craniectomy. Different antiplatelet strategies were employed in the two cases. Both patients survived and were discharged in stable condition. At 6-month follow-up, imaging demonstrated no evidence of aneurysm recurrence, and both children had a favorable quality of life.