Long-term outcomes of cerebral aneurysms in children

Abstract

BACKGROUND: Our aim was to report the long-term clinical and imaging outcomes of #15-year-old children treated for ruptured or symptomatic cerebral aneurysms and to identify prognostic factors for clinical outcome, recurrence, and rebleeding. METHODS: We retrospectively identified all pediatric cases of cerebral aneurysm from 2000 to 2015 and then prospectively evaluated long-term occlusion using brain MRI and clinical outcome measures: outcome was considered favorable if King’s Outcome Scale for Childhood Head Injury score was $5. We performed univariate analysis and logistic binary regression to identify variables associated with clinical and imaging outcomes. RESULTS: Fifty-one children (aged 8.5 6 1.1 years [mean 6 SD], with 37 ruptured and 14 symptomatic aneurysms) were included, and endovascular treatments (84%) or microsurgical procedures (16%) were performed. Despite a 19.6% death rate, at a mean follow-up of 8.3 years, 35 children (68.6%) had a favorable outcome. Annual bleeding and aneurysm recurrence rates were 1.4% 6 1.1% and 2.6% 6 1.8%, respectively. Cerebral ischemia, whether initial or delayed within the first month, was predictive of poor clinical outcome in multivariate analysis (odds ratio: 25; 95% confidence interval: 0.43–143; P, .0001), whereas aneurysm size .5 mm was the only factor associated with recurrence (odds ratio: 14.6; 95% confidence interval: 2.4–86.1; P = .003). CONCLUSIONS: Two-thirds of studied #15-year-old children suffering from ruptured or symptomatic cerebral aneurysms had long-term favorable outcome. Annual bleeding and aneurysm recurrence rates have shown to be low after endovascular or surgical treatment. Long-term imaging follow-up helps to depict aneurysm recurrence or de novo aneurysm formation and to prevent rebleeding.