{"id":{"repo_id":"helsinki","oai_identifier":"oai:helda.helsinki.fi:10138/37617"},"canonical_url":"https://search.dev.ndltd.org/etd/helsinki/oai:helda.helsinki.fi:10138/37617","repository":{"repo_id":"helsinki","name":"University of Helsinki","base_url":"https://helda.helsinki.fi/server/oai/request"},"display":{"title":"Pediatric cerebral artery aneurysms","abstract":"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.","abstract_html":"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.","abstract_has_math":false,"creators":["Koroknay-Pál, Päivi"],"institution":"Helsingin yliopisto","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2012,"date_issued":"2012-12-14","date_published":"2012-12-14","updated_at":"2026-08-21T22:21:56Z","subjects":["neurokirurgia"],"languages":["eng"],"rights":["Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.","This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.","Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/10138/37617","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"source_record":{"url":"https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F37617","prefix":"dim"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Koroknay-Pál, Päivi"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2012-11-23T07:52:22Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2012-12-04","2012-11-23T07:52:22Z"]},{"key":"dc:date.issued","label":"Date","values":["2012-12-14"]},{"key":"dc:publisher","label":"Institution","values":["Helsingin yliopisto","Helsingfors universitet","University of Helsinki"]},{"key":"dc:type.dcmitype","label":"Dc Type Dcmitype","values":["Text"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["neurokirurgia"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.","This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.","Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/10138/37617"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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.","Aivovaltimopullistuma on aivovaltimoiden haarautumiskohtaan muodostunut pallomainen pullistuma eli aneurysma. Aivovaltimoaneurysman puhkeaminen aiheuttaa hengenvaarallisen lukinkalvonalaisen aivoverenvuodon (SAV). Aivovaltimoaneurysmat ovat harvinaisia lapsilla. Tässä väitöstutkimuksessa suoritettiin pitkäaikaisseuranta Helsingissä Neurokirurgian klinikassa vuosien 1937-2009 aikana hoidetuille alle 18-vuotiaille aivovaltimoaneurysma-potilaille. Potilaiden ja aneurysmien erityispiirteet määritettiin, sekä selvitettiin potilaiden pitkän aikavälin sairastuvuus. Potilaiden ylikuolleisuus, eli kuolleisuuden lisäys verrattuna keskimääräiseen kaltaistettuun väestöön määritettiin. Näiden potilaiden riski saada uusia aneurysmia tai uusi aneurysmavuoto selvitettiin sekä arvioitiin näihin vaikuttavat riskitekijät. Seuranta-aikana hoidettiin 114 lapsianeurysma-potilasta, joilla oli yhteensä 130 aneurysmaa. Useimmat aneurysmista olivat vuotaneita ja keskikokoisia. Sisemmän kaulavaltimon huippu oli aneurysmien yleisin sijaintipaikka. Valtaosa potilaista oli poikia. Suurin osa aneurysmista hoidettiin kirurgisesti. 25 vuoden seurannassa valtaosa potilaista oli toipunut hyvin ja kolmasosa oli kuollut. Eloonjääneistä suurin osa asui itsenäisesti kotona ja oli työelämässä. Kolmasosa eloonjääneitä oli suorittanut vähintään lukion oppimäärän. Suotuisaan pitkän aikavälin ennusteeseen vaikuttivat aneurysman sijainti sisemmän kaulavaltimon alueella, kirurginen hoito ja täydellinen aneurysman sulku leikkauksesta. Neljäntoista (12%) potilaan suvussa oli taipumus aivovaltimoaneurysmiin. Viidelläkymmenelläyhdeksällä potilaalla oli radiologisia seurantatietoja aivovaltimoista. Potilaista 41%:lla todettiin uusi aivovaltimoaneurysma 34 vuoden seurannassa. Seitsemän potilaista oli sairastanut uuden SAV:n. Tupakointi oli ainoa merkittävä riskitekijä uuden aneurysman synnylle. Riski sairastua uuteen SAV:hen 40 vuotta ensimmäisen vuoden jälkeen oli 15%. Potilaiden ylikuolleisuus 20 vuoden seurannassa oli 10% ja 40 vuoden seurannassa 19%. Ylikuolleisuus oli erityisen korkea miespotilailla, ja aiheutui lähinnä aneurysmaan liittyvistä tekijöistä. Yhteenvetona voidaan todeta, että potilaat toipuivat hyvin, mutta lähes puolella heistä todettiin uusi aneurysman yli 34 vuoden seurannassa. Tupakointi oli ainoa merkittävä riskitekijä uuden aneurysman synnylle. Lapsuudessa aivovaltimoaneurysma-diagnoosin saaneilla potilailla on pitkäaikaisseurannassa ylikuolleisuutta vuosikymmeniä onnistuneenkin aneurysman hoidon jälkeen. Tämä ylikuolleisuus johtuu lähinnä aneurysmaan liittyvistä tekijöistä. Näiden potilaiden elinikäinen radiologinen seuranta on perusteltua."]},{"key":"dc:format.mimetype","label":"Dc Format Mimetype","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Pediatric cerebral artery aneurysms"]}]}],"canonical_facts":{"dc:creator":["Koroknay-Pál, Päivi"],"dc:date.accessioned":["2012-11-23T07:52:22Z"],"dc:date.available":["2012-12-04","2012-11-23T07:52:22Z"],"dc:date.issued":["2012-12-14"],"dc:description.abstract":["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.","Aivovaltimopullistuma on aivovaltimoiden haarautumiskohtaan muodostunut pallomainen pullistuma eli aneurysma. Aivovaltimoaneurysman puhkeaminen aiheuttaa hengenvaarallisen lukinkalvonalaisen aivoverenvuodon (SAV). Aivovaltimoaneurysmat ovat harvinaisia lapsilla. Tässä väitöstutkimuksessa suoritettiin pitkäaikaisseuranta Helsingissä Neurokirurgian klinikassa vuosien 1937-2009 aikana hoidetuille alle 18-vuotiaille aivovaltimoaneurysma-potilaille. Potilaiden ja aneurysmien erityispiirteet määritettiin, sekä selvitettiin potilaiden pitkän aikavälin sairastuvuus. Potilaiden ylikuolleisuus, eli kuolleisuuden lisäys verrattuna keskimääräiseen kaltaistettuun väestöön määritettiin. Näiden potilaiden riski saada uusia aneurysmia tai uusi aneurysmavuoto selvitettiin sekä arvioitiin näihin vaikuttavat riskitekijät. Seuranta-aikana hoidettiin 114 lapsianeurysma-potilasta, joilla oli yhteensä 130 aneurysmaa. Useimmat aneurysmista olivat vuotaneita ja keskikokoisia. Sisemmän kaulavaltimon huippu oli aneurysmien yleisin sijaintipaikka. Valtaosa potilaista oli poikia. Suurin osa aneurysmista hoidettiin kirurgisesti. 25 vuoden seurannassa valtaosa potilaista oli toipunut hyvin ja kolmasosa oli kuollut. Eloonjääneistä suurin osa asui itsenäisesti kotona ja oli työelämässä. Kolmasosa eloonjääneitä oli suorittanut vähintään lukion oppimäärän. Suotuisaan pitkän aikavälin ennusteeseen vaikuttivat aneurysman sijainti sisemmän kaulavaltimon alueella, kirurginen hoito ja täydellinen aneurysman sulku leikkauksesta. Neljäntoista (12%) potilaan suvussa oli taipumus aivovaltimoaneurysmiin. Viidelläkymmenelläyhdeksällä potilaalla oli radiologisia seurantatietoja aivovaltimoista. Potilaista 41%:lla todettiin uusi aivovaltimoaneurysma 34 vuoden seurannassa. Seitsemän potilaista oli sairastanut uuden SAV:n. Tupakointi oli ainoa merkittävä riskitekijä uuden aneurysman synnylle. Riski sairastua uuteen SAV:hen 40 vuotta ensimmäisen vuoden jälkeen oli 15%. Potilaiden ylikuolleisuus 20 vuoden seurannassa oli 10% ja 40 vuoden seurannassa 19%. Ylikuolleisuus oli erityisen korkea miespotilailla, ja aiheutui lähinnä aneurysmaan liittyvistä tekijöistä. Yhteenvetona voidaan todeta, että potilaat toipuivat hyvin, mutta lähes puolella heistä todettiin uusi aneurysman yli 34 vuoden seurannassa. Tupakointi oli ainoa merkittävä riskitekijä uuden aneurysman synnylle. Lapsuudessa aivovaltimoaneurysma-diagnoosin saaneilla potilailla on pitkäaikaisseurannassa ylikuolleisuutta vuosikymmeniä onnistuneenkin aneurysman hoidon jälkeen. Tämä ylikuolleisuus johtuu lähinnä aneurysmaan liittyvistä tekijöistä. Näiden potilaiden elinikäinen radiologinen seuranta on perusteltua."],"dc:format.mimetype":["application/pdf"],"dc:identifier.uri":["http://hdl.handle.net/10138/37617"],"dc:language.iso":["eng"],"dc:publisher":["Helsingin yliopisto","Helsingfors universitet","University of Helsinki"],"dc:rights":["Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.","This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.","Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden."],"dc:subject":["neurokirurgia"],"dc:title":["Pediatric cerebral artery aneurysms"],"dc:type.dcmitype":["Text"]},"updated_at":"2026-08-21T22:21:56Z"}