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Pediatrics. 2019 Jun;143(6). pii: e20183036. doi: 10.1542/peds.2018-3036. Epub 2019 May 8.

Long-term Outcomes of Cerebral Aneurysms in Children.

Author information

1
Department of Neurosurgery, La Pitié-Salpétrière Hospital, Université Paris Sorbonne, Paris, France; aymmed@hotmail.fr.
2
Departments of Pediatric Neurosurgery and.
3
Departments of Neuroradiology and.
4
Department of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; and.
5
Pediatric Radiology, Necker Hospital for Sick Children, Université Paris Descartes, Paris, France.
6
Department of Neuroradiology, Sainte-Anne Hospital and Université Paris Descartes, INSERM UMR S894, Paris, France.
7
Neurosurgery, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, France.

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.

PMID:
31068385
DOI:
10.1542/peds.2018-3036

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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