Pediatric cerebral artery aneurysms

Objectives. Intracranial aneurysms in children are rare and population-based long-term follow-up studies are limited. In this study, a large clinical and angiographic long-term follow-up was carried out. The special characteristics of the patients and their aneurysms were assessed together with factors affecting early and long-term morbidity and mortality. Materials and Methods. All pediatric (≤18 years) aneurysm patients treated at the Department of Neurosurgery in Helsinki during 1937-2009 were followed from diagnosis until death or the end of the year 2011. Later patient data were gathered from the referring hospitals, and a new follow-up was organized. The long-term excess mortality was calculated by using relative survival ratio. Results. Patients comprised 114 individuals with 130 aneurysms. Most aneurysms were ruptured and of medium size. Internal carotid artery bifurcation was the most common location, and boys were predominantly affected. The majority of the aneurysms were treated surgically. After a mean follow-up time of 25 years, 62% of the patients had a good outcome, 3% were dependent and 35% had died. Of the survivors, 91% lived independently at home and were meaningfully employed. Twenty-eight percent of the survivors were high school graduates. Factors correlating with a favorable long-term outcome were aneurysm location in the anterior circulation, operative treatment, and complete aneurysm closure postoperatively. Fourteen patients (12%) had a family history of aneurysms. Fifty-nine patients had long-term angiographic follow-up data (median follow-up 34 yrs). Of these patients, 41% were diagnosed with a total of 36 new aneurysms. Seven new subarachnoid hemorrhages (SAH) occurred. The annual rate of development of new aneurysm was 1.9% and that of hemorrhage 0.4%. Current or previous smoking (odds ratio 3.39, 95% confidence interval [CI] 1.02-11.29, p=0.047) was the only significant risk factor for new aneurysm formation. No independent risk factors for new SAH emerged. Cumulative risk of new SAH 40 years after the initial diagnosis was 15% (95% CI 5-25%). There was an overall excess mortality of 10% and 19% at 20 and 40 years after the diagnosis among the one-year survivors, respectively. The excess mortality was particularly high in male patients, and was mainly aneurysm-related. Conclusions. Most patients had a good recovery, but almost half of them developed new aneurysms during a follow-up of 34 years, with smoking being a major risk factor. A long-term excess mortality exists in pediatric aneurysm patients, especially males, even decades after successful treatment of a ruptured aneurysm. The excess mortality is mainly aneurysm-related. A life-long angiographic follow-up is mandatory in these patients.

Grantor dc:publisher

Helsingin yliopisto

Year dc:date.issued

2012

Author dc:creator

• Koroknay-Pál, Päivi

• neurokirurgia

Statement dc:rights

• Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
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• Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden.

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10138/37617

OAI record oai:identifier

https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F37617