**3. Characteristics of cerebral aneurysms in TSC**

#### **3.1 Case illustration**

A 2.5-year-old child presented with new-onset focal seizures characterized by rightward head deviation and rhythmic movements of the right arm. Seizures were treated with Vigabatrin and were controlled. The child was born at term of 37 weeks gestation to a healthy mother who had an uncomplicated pregnancy. Further evaluation revealed multiple rhabdomyomas on echocardiography, subependymal tubers on cranial MRI leading to the diagnosis of TSC. Additionally, a left cavernous lesion was detected on MRI. A TOF-MRA showed an 8-mm-diameter left cavernous ICA aneurysm. A year later, a control MRI revealed a rapid growth of the aneurysm whose diameter reached 15.5 mm (**Figure 1**). At the age of 14 months, the child

**175**

**Figure 1.**

*Demographic, Clinical, and Radiographic Characteristics of Cerebral Aneurysms in Tuberous…*

presented with his mother to our neurosurgical department. Because of the aneurysmal rapid growth, the decision to treat the aneurysm was made and a digital subtraction angiography (DSA) was performed (**Figure 2**). The aneurysm was treated by embolization and parent vessel occlusion. After treatment, the patient tolerated the

The collected series [11] showed a specific demographic pattern. In particular, the male/female ratio was 1.9:1 and 66.7% of the patients were under the age of 18,

Most IA in patients with TSC were diagnosed incidentally (36.4%) or due to a new onset of a neurological deficit (21.2%). IA were ruptured in only 7.1% of the cases [11].

The most frequent location of IA was the anterior circulation (85.7%) in favor of the ICA (61.9%), where aneurysms originated remote from branching zones. Of the 42 IA, 57.1% were large (size: 10–24 mm) or giant (size: ≥25 mm) and 45.2% had a fusiform configuration. Multiple aneurysms were seen only in 21.2% of the cases and a rapid growth was described and documented only in 2 patients (6%) [11, 13].

Cerebral aneurysms in TSC have distinct demographic, clinical and radiological features. Indeed, comparing TSC patients with those of the unruptured cerebral aneurysm Study of Japan (UCAS Japan) [14], significant differences are found between both series in the location on the ICA (61.9 vs. 34.1%, respectively), large/giant size (57.1 vs. 10.4%, respectively) and proportion of multiple

*TOF-MRA showing an incidental fusiform left cavernous ICA aneurysm (8 mm) of a 2.5-year-old child (a) with a rapid aneurysmal growth (+7.5 mm diameter within 12 months of period). (b) ICA: internal carotid artery,* 

total occlusion of the ICA and no neurological deficits were noticed.

*DOI: http://dx.doi.org/10.5772/intechopen.93802*

**3.2 Demographic characteristics**

**3.3 Clinical characteristics**

**3.4 Radiological characteristics**

among them 36.4% were 2 years of age or younger.

**3.5 Summary and comparison with other series**

*TOF-MRA: time-of-flight-magnetic resonance angiography.*

*Demographic, Clinical, and Radiographic Characteristics of Cerebral Aneurysms in Tuberous… DOI: http://dx.doi.org/10.5772/intechopen.93802*

presented with his mother to our neurosurgical department. Because of the aneurysmal rapid growth, the decision to treat the aneurysm was made and a digital subtraction angiography (DSA) was performed (**Figure 2**). The aneurysm was treated by embolization and parent vessel occlusion. After treatment, the patient tolerated the total occlusion of the ICA and no neurological deficits were noticed.
