Article
Pediatric cerebral aneurysms – a single centre experience
Zerebrale Aneurysmata in einer pädiatrischen Kohorte, Erfahrungen eines neurochirurgischen Zentrums
Search Medline for
Authors
Published: | May 25, 2022 |
---|
Outline
Text
Objective: To evaluate the treatment and outcome of pediatric patients with symptomatic cerebral aneurysms.
Methods: Retrospective analysis of all consecutive symptomatic pediatric patients that were treated with cerebral aneurysms between 1.1.2001 and 31.12.2021 in our institution. Size, location and morphology of the aneurysm as well as the treatment modality, the clinical condition as well as the outcome at the timepoint of the last follow up were evaluated.
Results: A total of 13 pediatric patients (age 11.2 +/- 6.9 y; 7 female and 6 male) with symptomatic cerebral aneurysms were treated during that time period. A giant aneurysm was present in 3 patients, a mycotic aneurysm was diagnosed in 2 patients, a genetic predisposition was present in 2 patients, and 1 aneurysm was developed post traumatically. 10 of the 13 patients were admitted with subarachnoid hemorrhage (SAH). 9 patients (69%) were treated surgically, 4 patients (31%) via endovascular means. During the course of treatment 8 patients had to undergo decompression surgery (62%) due to the extent of the initial associated cerebral hemorrhage or due to a large cerebral infarction. 5 patients (38%) developed hydrocephalus with the need for a shunt implantation after 63.2 +/- 41.0 days. 6 patients (46%) developed a permanent epilepsy including 2 patients who had to be additionally treated with hemispherotomy in the longer follow up. During our follow up (10.3 +/- 6.5 y) one patient died (7.7%). 9 patients (69%) developed complications (3 wound infections, 3 recurrent aneurysm, 2 bone flap necroses and 1 subdural hematoma). 5 patients had a GOS Score of 3, 2 patients a GOS score of 2 and 5 patients a GOS score of 1. Patients with an SAH had a significant worse outcome (GOS 2.6 +/- 1.2 vs. 1.0 +/- 0; p=0.043).
Conclusion: Pediatric cerebral aneurysms are a severe, rare and heterogeneous disease. Although the mortality rate in the pediatric cohort was lower, the need for decompressive hemicraniectomy and the rate of permanent epilepsy seems to be higher than what has previously been published in the adult population.