Endovascular Management of Pediatric Traumatic Intracranial Pseudoaneurysms: A Systematic Review and Case Series
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Published on: August 11, 2015
Lane Fry1, Aaron Brake1, Cody A Heskett1
1The University of Kansas School of Medicine, Kansas City, Kansas.
Insights
Pediatric intracranial pseudoaneurysms (IPAs) have high obliteration and favorable outcomes with various endovascular treatments. Direct aneurysm embolization showed higher recurrence, but all methods are safe and viable for treating pediatric IPAs.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Neurology
Background:
- Intracranial pseudoaneurysms (IPAs) in pediatric patients are rare but serious complications of head trauma or iatrogenic injury.
- Systematic review and retrospective analysis are crucial for understanding management and outcomes in this population.
Approach:
- A systematic literature review adhering to PRISMA guidelines was conducted.
- A retrospective analysis included pediatric patients treated for IPAs at a single institution.
- Data from 87 patients (88 IPAs) across 51 articles and the institution were analyzed.
Key Points:
- Parent vessel reconstruction, parent vessel occlusion, and direct aneurysm embolization (DAE) were primary treatment strategies.
- Complete aneurysm occlusion was achieved in 89.61% of cases, with 85.54% favorable clinical outcomes.
- DAE was associated with higher recurrence rates (P=0.009), and SAH correlated with worse outcomes (P=0.024).
Conclusions:
- Endovascular treatment of pediatric IPAs yields high rates of successful obliteration and favorable neurological outcomes.
- All evaluated treatment strategies, including DAE, parent vessel reconstruction, and parent vessel occlusion, are safe and effective.
- While DAE showed increased recurrence, the overall safety and efficacy of these interventions support their use in pediatric patients.
Objective:
This study aims to systematically review the management and outcomes of pediatric patients who develop intracranial pseudoaneurysm (IPA) following head trauma or iatrogenic injury.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was performed. Additionally, a retrospective analysis was conducted on pediatric patients who underwent evaluation and endovascular treatment for IPA originating from head trauma or iatrogenic injury at a single institution.
Results:
Two hundred twenty-one articles in the original literature search. Fifty-one met inclusion criteria resulting in a total of 87 patients with 88 IPAs including our institution. Patients ranged in age from 0.5 months to 18 years. Parent vessel reconstruction was used as first-line treatment in 43 cases, parent vessel occlusion in 26, and direct aneurysm embolization (DAE) in 19. Intraoperative complications were observed in 3.00% of procedures. Complete aneurysm occlusion was achieved in 89.61% of cases. 85.54% of cases resulted in favorable clinical outcomes. The mortality rate after treatment was 3.61%. The DAE group had higher rates of aneurysm recurrence than other treatment strategies (P = 0.009). Patients with SAH had overall worse outcomes compared to patients who did not (P = 0.024). There were no differences in favorable clinical outcomes (P = 0.274) or complete aneurysm occlusion (P = 0.13) between primary treatment strategies.
Conclusions:
IPAs were successfully obliterated, and favorable neurological outcomes were achieved at a high rate regardless of primary treatment strategy. DAE had a higher rate of recurrence than the other treatment groups. Each described treatment method in our review is safe and viable for the treatment of IPAs in pediatric patients.
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