Intra-aneurysmal superselective pharmacologic testing in a child

Treatment options for complex intracranial aneurysms with branch vessels originating from the fundus or neck are limited, because these arteries frequently supply eloquent brain territory. A 9-year-old boy presented with a recurrent proximal middle cerebral artery intracranial aneurysm. Sodium amobarbital was slowly injected through a microcatheter directly into the aneurysm fundus and an incorporated prominent lenticulostriate vessel for provocative functional testing. Serial neurologic examinations identified no new neurologic deficit. We proceeded with endovascular coiling of the aneurysm and inevitable sacrifice of the perforator vessel. The patient remained free of new neurologic symptoms with no angiographic evidence of aneurysm recurrence. To our knowledge, this is the youngest patient with a proximal intracranial aneurysm who has undergone superselective intra-aneurysmal provocative testing and subsequent successful endovascular treatment.