Epidemiology and outcomes of pediatric intracranial aneurysms: comparison with an adult population in a 30-year, prospective database

View More View Less
  • 1 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
  • | 2 Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Pediatric intracranial aneurysms are rare. Most large series in the last 15 years reported on an average of only 39 patients. The authors sought to report their institutional experience with pediatric intracranial aneurysms from 1991 to 2021 and to compare pediatric patient and aneurysm characteristics with those of a contemporaneous adult cohort.

METHODS

Pediatric (≤ 18 years of age) and adult patients with one or more intracranial aneurysms were identified in a prospective database. Standard epidemiological features and outcomes of each pediatric patient were retrospectively recorded. These results were compared with those of adult aneurysm patients managed at a single institution over the same time period.

RESULTS

From a total of 4500 patients with 5150 intracranial aneurysms admitted over 30 years, there were 47 children with 53 aneurysms and 4453 adults with 5097 aneurysms; 53.2% of children and 36.4% of adults presented with a subarachnoid hemorrhage (SAH). Pediatric aneurysms were significantly more common in males, more likely giant (≥ 25 mm), and most frequently located in the middle cerebral artery. Overall, 85.1% of the pediatric patients had a modified Rankin Scale score ≤ 2 at the last follow-up (with a mean follow-up of 65.9 months), and the pediatric mortality rate was 10.6%; all 5 patients who died had an SAH. The recurrence rate of treated aneurysms was 6.7% (1/15) in the endovascular group but 0% (0/31) in the microsurgical group. No de novo aneurysms occurred in children (mean follow-up 5.5 years).

CONCLUSIONS

Pediatric intracranial aneurysms are significantly different from adult aneurysms in terms of sex, presentation, location, size, and outcomes. Future prospective studies will better characterize long-term aneurysm recurrence, rebleeds, and de novo aneurysm occurrences. The authors currently favor microsurgical over endovascular treatment for pediatric aneurysms.

ABBREVIATIONS

ACA = anterior cerebral artery; AVM = arteriovenous malformation; EVD = external ventricular drain; ICA = internal carotid artery; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCA = posterior cerebral artery; SAH = subarachnoid hemorrhage.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Rafael J. Tamargo: Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD. rtamarg@jhmi.edu.

INCLUDE WHEN CITING Published online September 10, 2021; DOI: 10.3171/2021.6.PEDS21268.

Disclosures Christopher M. Jackson: scientific founder and CMO of Egret Therapeutics.

  • 1

    Krishna H, Wani AA, Behari S, Banerji D, Chhabra DK, Jain VK. Intracranial aneurysms in patients 18 years of age or under, are they different from aneurysms in adult population?. Acta Neurochir (Wien). 2005;147(5):469476.

    • Search Google Scholar
    • Export Citation
  • 2

    Vasan R, Patel J, Sweeney JM, Carpenter AM, Downes K, Youssef AS, et al. Pediatric intracranial aneurysms: current national trends in patient management and treatment. Childs Nerv Syst. 2013;29(3):451456.

    • Search Google Scholar
    • Export Citation
  • 3

    Alawi A, Edgell RC, Elbabaa SK, Callison RC, Khalili YA, Allam H, Alshekhlee A. Treatment of cerebral aneurysms in children: analysis of the Kids’ Inpatient Database. J Neurosurg Pediatr. 2014;14(1):2330.

    • Search Google Scholar
    • Export Citation
  • 4

    Bhogal P, Pérez MA, Wendl C, Bäzner H, Ganslandt O, Henkes H. Paediatric aneurysms—review of endovascular treatment strategies. J Clin Neurosci. 2017;45:5459.

    • Search Google Scholar
    • Export Citation
  • 5

    Colby GP, Jiang B, Bender MT, Beaty NB, Westbroek EM, Xu R, et al. Pipeline-assisted coil embolization of a large middle cerebral artery pseudoaneurysm in a 9-month-old infant: experience from the youngest flow diversion case. J Neurosurg Pediatr. 2018;22(5):532540.

    • Search Google Scholar
    • Export Citation
  • 6

    Deutschmann HA, Augustin M, Simbrunner J, Unger B, Schoellnast H, Fritz GA, Klein GE. Diagnostic accuracy of 3D time-of-flight MR angiography compared with digital subtraction angiography for follow-up of coiled intracranial aneurysms: influence of aneurysm size. AJNR Am J Neuroradiol. 2007;28(4):628634.

    • Search Google Scholar
    • Export Citation
  • 7

    Fulkerson DH, Voorhies JM, Payner TD, Leipzig TJ, Horner TG, Redelman K, Cohen-Gadol AA. Middle cerebral artery aneurysms in children: case series and review. J Neurosurg Pediatr. 2011;8(1):7989.

    • Search Google Scholar
    • Export Citation
  • 8

    Jian BJ, Hetts SW, Lawton MT, Gupta N. Pediatric intracranial aneurysms. Neurosurg Clin N Am. 2010;21(3):491501.

  • 9

    Kim M, Lee HS, Lee S, Park JC, Ahn JS, Kwon DH, et al. Pediatric intracranial aneurysms: favorable outcomes despite rareness and complexity. World Neurosurg. 2019;125:e1203e1216.

    • Search Google Scholar
    • Export Citation
  • 10

    Krings T, Geibprasert S, terBrugge KG. Pathomechanisms and treatment of pediatric aneurysms. Childs Nerv Syst. 2010;26(10):13091318.

  • 11

    Liang J, Bao Y, Zhang H, Wrede KH, Zhi X, Li M, Ling F. The clinical features and treatment of pediatric intracranial aneurysm. Childs Nerv Syst. 2009;25(3):317324.

    • Search Google Scholar
    • Export Citation
  • 12

    Lv X, Jiang C, Li Y, Yang X, Wu Z. Endovascular treatment for pediatric intracranial aneurysms. Neuroradiology. 2009;51(11):749754.

  • 13

    Nam SM, Jang D, Wang KC, Kim SK, Phi JH, Lee JY, et al. Characteristics and treatment outcome of intracranial aneurysms in children and adolescents. J Korean Neurosurg Soc. 2019;62(5):551560.

    • Search Google Scholar
    • Export Citation
  • 14

    Navarro R, Brown BL, Beier A, Ranalli N, Aldana P, Hanel RA. Flow diversion for complex intracranial aneurysms in young children. J Neurosurg Pediatr. 2015;15(3):276281.

    • Search Google Scholar
    • Export Citation
  • 15

    Saleh E, Dawson RC III. Endovascular management of pediatric aneurysms. Neuroradiol J. 2011;24(5):693698.

  • 16

    Saraf R, Shrivastava M, Siddhartha W, Limaye U. Intracranial pediatric aneurysms: endovascular treatment and its outcome. J Neurosurg Pediatr. 2012;10(3):230240.

    • Search Google Scholar
    • Export Citation
  • 17

    Slator N, Talibi SS, Mundil N, Thomas A, Lamin S, Walsh R, et al. Paediatric intracranial aneurysms: a British institutional review. Childs Nerv Syst. 2019;35(7):11971205.

    • Search Google Scholar
    • Export Citation
  • 18

    Sorteberg A, Dahlberg D. Intracranial non-traumatic aneurysms in children and adolescents. Curr Pediatr Rev. 2013;9(4):343352.

  • 19

    Stiefel MF, Heuer GG, Basil AK, Weigele JB, Sutton LN, Hurst RW, Storm PB. Endovascular and surgical treatment of ruptured cerebral aneurysms in pediatric patients. Neurosurgery. 2008;63(5):859866.

    • Search Google Scholar
    • Export Citation
  • 20

    Vaid VK, Kumar R, Kalra SK, Mahapatra AK, Jain VK. Pediatric intracranial aneurysms: an institutional experience. Pediatr Neurosurg. 2008;44(4):296301.

    • Search Google Scholar
    • Export Citation
  • 21

    Huang J, McGirt MJ, Gailloud P, Tamargo RJ. Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol. 2005;63(5):424433.

    • Search Google Scholar
    • Export Citation
  • 22

    International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med. 1998;339(24):17251733.

    • Search Google Scholar
    • Export Citation
  • 23

    Chen R, Zhang S, You C, Guo R, Ma L. Pediatric intracranial aneurysms: changes from previous studies. Childs Nerv Syst. 2018;34(9):16971704.

    • Search Google Scholar
    • Export Citation
  • 24

    Cherian J, Srinivasan V, Froehler MT, Grossberg JA, Cawley CM, Hanel RA, et al. Flow diversion for treatment of intracranial aneurysms in pediatric patients: multicenter case series. Neurosurgery. 2020;87(1):5362.

    • Search Google Scholar
    • Export Citation
  • 25

    Hetts SW, Narvid J, Sanai N, Lawton MT, Gupta N, Fullerton HJ, et al. Intracranial aneurysms in childhood: 27-year single-institution experience. AJNR Am J Neuroradiol. 2009;30(7):13151324.

    • Search Google Scholar
    • Export Citation
  • 26

    Koroknay-Pál P, Lehto H, Niemelä M, Kivisaari R, Hernesniemi J. Long-term outcome of 114 children with cerebral aneurysms. J Neurosurg Pediatr. 2012;9(6):636645.

    • Search Google Scholar
    • Export Citation
  • 27

    Sanai N, Quinones-Hinojosa A, Gupta NM, Perry V, Sun PP, Wilson CB, Lawton MT. Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg. 2006;104(2)(suppl):8289.

    • Search Google Scholar
    • Export Citation
  • 28

    Takemoto K, Tateshima S, Golshan A, Gonzalez N, Jahan R, Duckwiler G, Vinuela F. Endovascular treatment of pediatric intracranial aneurysms: a retrospective study of 35 aneurysms. J Neurointerv Surg. 2014;6(6):432438.

    • Search Google Scholar
    • Export Citation
  • 29

    Bakker MK, van der Spek RAA, van Rheenen W, Morel S, Bourcier R, Hostettler IC, et al. Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors. Nat Genet. 2020;52(12):13031313.

    • Search Google Scholar
    • Export Citation
  • 30

    Carmichael R. The pathogenesis of noninflammatory cerebral aneurysms. J Pathol Bacteriol. 1950;62(1):119.

  • 31

    Abeywardana S, Sullivan EA. Congenital Anomalies in Australia 2002-2003. Australian Institute of Health and Welfare National Perinatal Statistics Unit; 2008.

    • Search Google Scholar
    • Export Citation
  • 32

    Beez T, Steiger HJ, Hänggi D. Evolution of management of intracranial aneurysms in children: a systematic review of the modern literature. J Child Neurol. 2016;31(6):773783.

    • Search Google Scholar
    • Export Citation
  • 33

    Agid R, Souza MP, Reintamm G, Armstrong D, Dirks P, TerBrugge KG. The role of endovascular treatment for pediatric aneurysms. Childs Nerv Syst. 2005;21(12):10301036.

    • Search Google Scholar
    • Export Citation
  • 34

    Darsaut TE, Jack AS, Kerr RS, Raymond J. International Subarachnoid Aneurysm Trial—ISAT part II: study protocol for a randomized controlled trial. Trials. 2013;14:156.

    • Search Google Scholar
    • Export Citation
  • 35

    Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Nakaji P, et al. Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2019;132(3):771776.

    • Search Google Scholar
    • Export Citation
  • 36

    Deora H, Rao KVLN, Somanna S, Srinivas D, Shukla DP, Bhat DI. Surgically managed pediatric intracranial aneurysms: how different are they from adult intracranial aneurysms?. Pediatr Neurosurg. 2017;52(5):313317.

    • Search Google Scholar
    • Export Citation
  • 37

    Garg K, Singh PK, Sharma BS, Chandra PS, Suri A, Singh M, et al. Pediatric intracranial aneurysms—our experience and review of literature. Childs Nerv Syst. 2014;30(5):873883.

    • Search Google Scholar
    • Export Citation
  • 38

    Gross BA, Smith ER, Scott RM, Orbach DB. Intracranial aneurysms in the youngest patients: characteristics and treatment challenges. Pediatr Neurosurg. 2015;50(1):1825.

    • Search Google Scholar
    • Export Citation
  • 39

    Kakarla UK, Beres EJ, Ponce FA, Chang SW, Deshmukh VR, Bambakidis NC, et al. Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes. Neurosurgery. 2010;67(2):237250.

    • Search Google Scholar
    • Export Citation
  • 40

    Lasjaunias P, Wuppalapati S, Alvarez H, Rodesch G, Ozanne A. Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst. 2005;21(6):437450.

    • Search Google Scholar
    • Export Citation
  • 41

    Mehrotra A, Nair AP, Das KK, Srivastava A, Sahu RN, Kumar R. Clinical and radiological profiles and outcomes in pediatric patients with intracranial aneurysms. J Neurosurg Pediatr. 2012;10(4):340346.

    • Search Google Scholar
    • Export Citation
  • 42

    Requejo F, Ceciliano A, Cardenas R, Villasante F, Jaimovich R, Zuccaro G. Cerebral aneurysms in children: are we talking about a single pathological entity?. Childs Nerv Syst. 2010;26(10):13291335.

    • Search Google Scholar
    • Export Citation
  • 43

    Sharma BS, Sinha S, Mehta VS, Suri A, Gupta A, Mahapatra AK. Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment. Childs Nerv Syst. 2007;23(3):327333.

    • Search Google Scholar
    • Export Citation
  • 44

    Yasin JT, Wallace AN, Madaelil TP, Osbun JW, Moran CJ, Cross DT, et al. Treatment of pediatric intracranial aneurysms: case series and meta-analysis. J Neurointerv Surg. 2019;11(3):257264.

    • Search Google Scholar
    • Export Citation
  • 45

    Amelot A, Saliou G, Benichi S, Alias Q, Boulouis G, Zerah M, et al. Long-term outcomes of cerebral aneurysms in children. Pediatrics. 2019;143(6):e20183036.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 344 344 344
Full Text Views 58 58 58
PDF Downloads 99 99 99
EPUB Downloads 0 0 0