Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p &lt; 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p &lt; 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.</jats:p></jats:sec>

Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child

“…This increase may be due to the International Subarachnoid Aneurysm Trial (ISAT) results [21] trending toward endovascular management, associated with the parental tendency to refuse open brain surgery [4]. Although observational studies have also suggested that children treated by endovascular therapy had a better outcome than those treated by surgical clipping, most of them are uncontrolled and small [22]. Agid et al [3] found good results in 77% of their endovascular group against only 44% in the surgically treated group, independently of Hunt and Hess grading.…”

“…Lasjaunias et al [2] also reported a better outcome with endovascular treatment, with 7 of 8 treated patients having a good outcome. In a database analysis of 1,120 children, Alawi et al [22] found an overall in-hospital mortality that was threefold lower in the coil embolization group in comparison to the surgical clipping group, with higher risks of hydrocephalus, systemic infections and pulmonary complications in the latter. Likewise, infants had the highest mortality rate compared to other children, possibly related to greater tendency to hemorrhage and higher prevalence of posterior circulation giant aneurysms [22].…”

“…In a database analysis of 1,120 children, Alawi et al [22] found an overall in-hospital mortality that was threefold lower in the coil embolization group in comparison to the surgical clipping group, with higher risks of hydrocephalus, systemic infections and pulmonary complications in the latter. Likewise, infants had the highest mortality rate compared to other children, possibly related to greater tendency to hemorrhage and higher prevalence of posterior circulation giant aneurysms [22]. There is no described minimum age to endovascular treatment, thus this modality may be preferable in early childhood, considering the intricate physiologic requirements and limited blood volume [10,11].…”

Big Data Research in Pediatric Neurosurgery: Content, Statistical Output, and Bibliometric Analysis

“…Studies seeking to investigate relatively rare pediatric diseases or conditions would be relevant applications of big data as these inquiries would be supported by much larger sample sizes than are obtainable by individual centers. Notable examples of such studies include wartime head injury, myelomeningocele, cerebral aneurysms, and venous thromboembolism in children with traumatic brain injury [40-44]. Big data can provide information on the associations of hospital type, provider caseload, and geography with outcomes, as has been nicely done for pediatric brain tumors, shunt surgery, and cerebrovascular pathology [37, 38, 45].…”

Endovascular Reconstruction of Intracranial Aneurysms with the Pipeline Embolization Device in Pediatric Patients: A Single-Center Series

“…Furthermore, aneurysms in the cavernous segment of the ICA, which are often difficult to treat with microsurgery, can readily be approached by endovascular methods [19]. Endovascular treatment of aneurysms is associated with lower mortality compared to microsurgical clipping in the pediatric population [20]. …”