Long-term Outcomes of Cerebral Aneurysms in Children

Abstract

BACKGROUND: Our aim was to report the long-term clinical and imaging outcomes of ≤15-year-old children treated for ruptured or symptomatic cerebral aneurysms and to identify prognostic factors for clinical outcome, recurrence, and rebleeding. METHODS: We retrospectively identified all pediatric cases of cerebral aneurysm from 2000 to 2015 and then prospectively evaluated long-term occlusion using brain MRI and clinical outcome measures: outcome was considered favorable if King’s Outcome Scale for Childhood Head Injury score was ≥5. We performed univariate analysis and logistic binary regression to identify variables associated with clinical and imaging outcomes. RESULTS: Fifty-one children (aged 8.5 ± 1.1 years [mean ± SD], with 37 ruptured and 14 symptomatic aneurysms) were included, and endovascular treatments (84%) or microsurgical procedures (16%) were performed. Despite a 19.6% death rate, at a mean follow-up of 8.3 years, 35 children (68.6%) had a favorable outcome. Annual bleeding and aneurysm recurrence rates were 1.4% ± 1.1% and 2.6% ± 1.8%, respectively. Cerebral ischemia, whether initial or delayed within the first month, was predictive of poor clinical outcome in multivariate analysis (odds ratio: 25; 95% confidence interval: 0.43–143; P < .0001), whereas aneurysm size >5 mm was the only factor associated with recurrence (odds ratio: 14.6; 95% confidence interval: 2.4–86.1; P = .003). CONCLUSIONS: Two-thirds of studied ≤15-year-old children suffering from ruptured or symptomatic cerebral aneurysms had long-term favorable outcome. Annual bleeding and aneurysm recurrence rates have shown to be low after endovascular or surgical treatment. Long-term imaging follow-up helps to depict aneurysm recurrence or de novo aneurysm formation and to prevent rebleeding.

Characteristics and surgical outcomes of pediatric intracranial aneurysms in romania

“…High-potential leptomeningeal circulation also plays an important role in decreasing the effect of vasospasm (15). Aneurysm rebleeding after SAH appears in 52-60% cases, and reports regarding its outcomes have conflicted among studies (3,20). While one study identified aneurysm rebleeding as the primary cause of mortality (76% of total deaths), another case series reported that approximatively 80% of rebleeding cases were associated with good postoperative outcomes (3,17).…”

Endovascular treatment of intracranial vascular malformations in children

“…17 Prognosis and follow-up Some authors showed that, despite a death rate of about 20%, two-thirds of children younger than 15 years who suffered from ruptured or symptomatic cerebral aneurysms had long-term favourable outcomes. 20 Cerebral ischaemia occurring initially or delayed within the first few months was a factor of poor clinical outcome, and an aneurysm larger than 5mm was the only factor associated with recurrence. 20 The longer anticipated lifespan and greater recurrence risk of paediatric intracranial aneurysms explain why these patients need an aggressive therapeutic approach with cure as the goal and a lifelong imaging follow-up to detect aneurysm recurrence and de novo aneurysm formation.…”

“…20 Cerebral ischaemia occurring initially or delayed within the first few months was a factor of poor clinical outcome, and an aneurysm larger than 5mm was the only factor associated with recurrence. 20 The longer anticipated lifespan and greater recurrence risk of paediatric intracranial aneurysms explain why these patients need an aggressive therapeutic approach with cure as the goal and a lifelong imaging follow-up to detect aneurysm recurrence and de novo aneurysm formation. 19,20 As in the adult population, for patients with unruptured aneurysms there were no clear clinical data to propose a conservative attitude or any other treatment.…”

“…20 The longer anticipated lifespan and greater recurrence risk of paediatric intracranial aneurysms explain why these patients need an aggressive therapeutic approach with cure as the goal and a lifelong imaging follow-up to detect aneurysm recurrence and de novo aneurysm formation. 19,20 As in the adult population, for patients with unruptured aneurysms there were no clear clinical data to propose a conservative attitude or any other treatment. 21 Given the limitations imposed by these non-random studies and the relatively short duration of clinical follow-up, we believe What this paper adds…”

“…Some authors showed that, despite a death rate of about 20%, two‐thirds of children younger than 15 years who suffered from ruptured or symptomatic cerebral aneurysms had long‐term favourable outcomes 20 . Cerebral ischaemia occurring initially or delayed within the first few months was a factor of poor clinical outcome, and an aneurysm larger than 5mm was the only factor associated with recurrence 20 …”