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046. Pediatric Intracranial Aneurysm Treatment: single surgeon experience (1989-2020)

Authors: Jillian H. Plonsker, MD

Introduction:
Intracranial aneurysms are rare in pediatric patients and thus poorly understood. Despite similarities with adult management, decisions are affected by the need for durability due to pediatric patients’ long-life expectancy, blood loss intolerance, and remarkable ability for neurologic recovery. We present a large series of pediatric aneurysms managed by a single surgeon at our institution and describe our experience with both open and endovascular modalities.Methods: All patients age < 18 treated for ruptured or unruptured intracerebral aneurysm by surgeon ML between 1989 and 2020 were retrospectively reviewed. Patients who underwent expectant management for their aneurysm were excluded.
Results:
83 patients were included. Mean age was 10.09 (+/- 5.91). Most patients (n=56, 67%), presented with rupture and 33 (59%) were classified as Hunt Hess 1-2. Unruptured aneurysms presented with neurologic deficit, headache or were incidental. 28 (29%) aneurysms were in the posterior circulation, and 55 (66%) were located in the anterior circulation. 21 (25%) were classified as giant. 5 patients (6%) had multiple aneurysms. 72 (86%) were treated with surgery only, 5 (6%) underwent surgical and endovascular treatment, and 6 (7%) received endovascular therapy only. The average follow-up was 9.5 +/- 10.6 years. 13 patients (16%) required permanent CSF diversion, and 66 (80%) had mRS score of 0-2 at last follow-up. Post-operative complications included delayed rupture (n=3), aneurysm recurrence (n=1), neurologic deficit (n=7), delayed ischemic stroke (n=3), and infection (n=2).
Conclusion:
Although pediatric intracranial aneurysms are rare, large single-institution series with long follow-up provide insight into their natural history and nuances of management. Most patients in our series had anterior circulation aneurysms, presented with rupture, and had good functional outcomes. Patients underwent microsurgical resection, endovascular treatment, or both depending on aneurysm location and morphology, with relatively low rates of delayed rupture or recurrence.