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Pediatric infectious aneurysms: individual patient pooled analysis on presentation, management and outcomes
  1. Ali Alawieh1,
  2. Youssef M Zohdy1,
  3. Rim El Annan1,
  4. Jad H Assi1,
  5. Laurie Dimisko2,
  6. Jonathan A Grossberg1,
  7. C Michael Cawley1,3,
  8. Katherine Chandler1,
  9. Joshua J Chern1,4,
  10. Michael S Sawvel1,4,
  11. Barunashish Brahma1,4,
  12. Tomas Garzon-Muvdi1,
  13. Gustavo Pradilla1,
  14. Daniel Barrow1,
  15. Andrew Reisner1,4,
  16. Brian M Howard1,3
  1. 1Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
  2. 2Emory Healthcare, Atlanta, Georgia, USA
  3. 3Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
  1. Correspondence to Dr Brian M Howard, Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA; brian.howard{at}emory.edu; Dr Andrew Reisner, Department of Neurosurgery, Childrens Healthcare of Atlanta, 1001 Johnson Ferry Road NE, Atlanta, GA 30342, USA; andrew.reisner{at}choa.org

Abstract

Background Infectious intracranial aneurysms (IIAs) are a rare sequel of systemic infection and occur most commonly in patients with infective endocarditis (IE). Despite the increasing use of non-invasive screening angiography in patients with IE, the incidence remains low, yielding limited data on the management of IIAs in pediatric populations. We performed a pooled analysis of all published series of pediatric patients with IIAs to study the disease landscape including presentation, management, and outcomes.

Methods Data included in this study were pooled from published literature on IIAs between 1960 and 2023. Abstracts were selected for full review to include only manuscripts reporting at least one case of pediatric IIA (age 0–18 years).

Results A total of 145 pediatric patients with 178 IIAs were included. Patients presented with rupture in 68% of cases, of which 36% had intraparenchymal hemorrhage and 39% had subarachnoid hemorrhage. Using multivariate logistic regression, independent predictors of rupture were posterior location (aOR 10, P=0.041) and history of IE (aOR 7.2, P=0.001). Primary medical management was successful in 82% of cases with unruptured aneurysms while, in those with ruptured IIAs, medical management was successful in 26% of cases. The 90-day mortality rate was 28%. Using multivariate logistic regression, ruptured IIAs (aOR 5.4, P<0.01) and failure of medical management (aOR 11.1, P<0.05) were independent predictors of 90-day mortality.

Conclusion Pediatric IIAs remain a rare complication of systemic or localized CNS infection in the pediatric population. Medical management of unruptured aneurysms is highly successful, while ruptured aneurysms have a remarkably high rate of failure of medical management and should be treated by early surgical or endovascular intervention when feasible.

  • aneurysm
  • pediatrics
  • infection
  • hemorrhage

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @JAGrossbergMD, @BrianHoward_MD

  • AA and YMZ contributed equally.

  • Contributors AA, LD, YMZ performed title and abstract screening. Selected publications were reviewed for individual patient variables by AA, YMZ, LD, REA, JHA, KC. Analysis and first draft writing was done by AA and YMZ. Manuscript was reviewed and edited by JAG, CMC, JJC, MSS, BB, TG-M and GP. The work was supervised and validated by DB, AR and BMH. All authors approved the final version of the submission. AR and BMH are co-corresponding authors and guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.