066. Patterns in the Treatment of Pediatric Brain Aneurysms

Authors: Anna Leigh Slingerland

The natural history and management of brain aneurysms is different in children compared to adults and is not well reported. We identified treatment trends and outcomes of pediatric brain aneurysms at a national level and compared this with the experience at one high-volume pediatric hospital.Methods: Children with cerebral aneurysms or aneurysmal subarachnoid hemorrhage in the United States were identified using the Kids’ Inpatient Database (KID) from 2000 to 2016, and assessed with multivariate regression for differences in mortality rates, length of stay, hospital charges, and discharge disposition. We identified the characteristics, treatment, and outcome of pediatric intracranial aneurysms diagnosed at our institution between 2010 and 2020. To compare with adult management approaches, each unruptured, saccular aneurysm was analyzed using the Unruptured Intracranial Aneurysm Treatment Score (UIATS) Model.
Of 3295 children with intracranial aneurysms nationally, 890 (27%) were treated. In total, 527 children (60.5%) underwent endovascular treatment while 344 (39.5%) underwent clipping. Coiling increased from 44.4% of treatments in 2000-2003 to 60.1% in 2016 (p= 0.001). Patients who received clipping stayed a median of two extra days in the hospital (p= 0.015). The treatment type did not impact cost, likelihood of discharge home, or mortality rate. Rupture status and number of comorbidities were the determinants of these outcomes. At our institution, 34 out of 135 pediatric aneurysms (25.2%) were treated: 14 (41.2%) surgically and 20 (58.8%) endovascularly. Over an average follow-up of 2.3 years, no untreated aneurysms (n= 101) ruptured, and 17 (16.8%) demonstrated growth. In total, 11.1% of qualifying aneurysms were managed differently in the children at our institution than in the UIATS model of adult patients.
Like in adults, brain aneurysms in children are increasingly treated using endovascular approaches. However, aneurysms in children may have a different management paradigm than in adults.