Pediatric Posterior Circulation Aneurysms: A Distinct Entity Treated with Flow Diversion

BACKGROUND AND PURPOSE: Flow diversion has transformed the treatment of intracranial aneurysms; however, data on pediatric posterior circulation aneurysms remain limited. The purpose of this study is to evaluate flow diversion in pediatric intracranial posterior circulation aneurysms. MATERIALS AND METHODS: Pediatric intracranial posterior circulation aneurysms treated by flow diverters in a tertiary referral center between 2014 and 2025 were identified and reviewed retrospectively for patient characteristics, angiographic and clinical results of flow diversion. RESULTS: During this period, all the 11 children (6 boys, median age: 14; age range: 6 - 19) who presented with 15 pediatric intracranial posterior circulation aneurysms were treated with flow diversion. Their aneurysms were of fusiform/dissecting type, yet, distinct from the dolichoectatic forms of the vertebrobasilar aneurysms as seen in adults. Two of them had bled previously. The median size/length of the index aneurysms (larger aneurysm in case of tandem aneurysms) was 27 mm and three of them were classified as complex aneurysms demanding multi-device endovascular arterial reconstructions. All embolization procedures were technically successful, without any procedure-related permanent neurological morbidity or mortality on follow-up. One child died because of the consequences of her underlying disease. At a median imaging follow-up of 47 months (3 - 89 months), residual opacification remained in one aneurysm (9.1% of patients, 6.7% of aneurysms) whereas infundibular opacification of efferent arteries was noted in 2 children. CONCLUSION: In this single-center series, pediatric posterior circulation aneurysms treated with flow diversion were predominantly large or giant fusiform/dissecting lesions requiring individualized reconstructive strategies. Flow diversion was technically feasible and associated with favorable long-term angiographic and clinical outcomes in this cohort. Flow diversion represents a viable option for these aneurysms.