RT Journal Article
SR Electronic
T1 Pediatric infectious aneurysms: individual patient pooled analysis on presentation, management and outcomes
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP jnis-2023-021195
DO 10.1136/jnis-2023-021195
A1 Alawieh, Ali
A1 Zohdy, Youssef M
A1 El Annan, Rim
A1 Assi, Jad H
A1 Dimisko, Laurie
A1 Grossberg, Jonathan A
A1 Cawley, C Michael
A1 Chandler, Katherine
A1 Chern, Joshua J
A1 Sawvel, Michael S
A1 Brahma, Barunashish
A1 Garzon-Muvdi, Tomas
A1 Pradilla, Gustavo
A1 Barrow, Daniel
A1 Reisner, Andrew
A1 Howard, Brian M
YR 2024
UL http://jnis.bmj.com/content/early/2024/01/03/jnis-2023-021195.abstract
AB 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.All data relevant to the study are included in the article or uploaded as supplementary information.