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Intracranial arterial aneurysms in children and adolescents
Insights
Pediatric intracranial saccular aneurysms are rare but serious, with subarachnoid bleeding common. Intracerebral hematomas significantly increase mortality risk in children with these aneurysms.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Neurology
Background:
- Intracranial saccular aneurysms are uncommon in pediatric patients.
- Subarachnoid bleeding is a frequent presenting symptom in young individuals with these aneurysms.
Purpose of the Study:
- To analyze the clinical characteristics, treatment, and outcomes of pediatric patients with intracranial saccular aneurysms.
- To investigate the prognostic significance of cerebral vasospasm and intracerebral hematomas in this population.
Main Methods:
- Retrospective review of 1368 patients treated for intracranial saccular aneurysms between 1943 and 1980.
- Analysis of 43 pediatric patients (≤19 years) including clinical presentation, Hunt and Hess grading, vasospasm, hematoma presence, and long-term outcomes.
- Statistical comparison of mortality and morbidity based on the presence of intracerebral hematoma.
Main Results:
- Pediatric aneurysms occurred in 3.1% of patients, with 77% presenting with subarachnoid bleeding.
- Cerebral vasospasm was observed in 53% of patients but did not increase morbidity or mortality.
- Intracerebral hematomas were present in 37% of pediatric cases, associated with a 50% mortality rate compared to 26% without hematoma. Overall mortality was 33%.
Conclusions:
- Intracerebral hematomas are a significant negative prognostic factor in pediatric intracranial saccular aneurysms.
- Cerebral vasospasm may have a minor prognostic role in children with ruptured aneurysms.
- Despite high mortality, a majority of surviving pediatric patients achieved good recovery.
Abstract:
Throughout the period 1943 to 1980, 1368 patients with verified intracranial saccular aneurysms were treated in the University of Aarhus neurosurgical department. Forty-three (3.1%) patients (25 boys and 18 girls) were 19 years old or younger, and 33 (77%) had an onset of symptoms typical of subarachnoid bleeding. Using the classification system of Hunt and Hess as a basis for clinical assessment on admission, 58% of the patients could be placed in Grade I or II. Cerebral vasospasm was demonstrated in 53% of the patients undergoing angiography between the 4th and 16th day after hemorrhage. There was no increased morbidity or mortality in the group of patients with vasospasm, and no cerebral infarction was demonstrated at necropsy. Therefore, it is possible that vasospasm is of minor prognostic significance in children. In 15 patients (37%), aneurysm rupture was accompanied by intracerebral hematoma. The mortality rate in this group of 15 patients was 50%, whereas in the group without hematoma it was 26%. The overall mortality rate was 33%. The surviving 29 patients were followed for 3 months to 14 years. Twenty-three patients made a good recovery (80% of survivors and 54% of the total series), five were moderately disabled, and one was severely disabled.