背景:与成人颅内动脉瘤相比,小儿颅内动脉瘤(IA)很少见,并且具有不同的临床特征。它们的位置不同,尺寸,形态学,介绍,和治疗策略。我们介绍了我们在18年期间使用手术和血管内治疗的儿科IAS的经验,并回顾了文献以确定流行病学的共性。治疗,和结果。
方法:我们确定了2005年至2020年间在我们机构接受IA治疗的所有<20岁的患者。医疗记录和影像学检查人口统计,临床,和操作数据。进行了系统评价,以确定报告儿科IAs手术和血管内治疗的主要结果的研究。人口统计信息,动脉瘤特征,治疗策略,并收集结果。
结果:33例患者在18年内接受了37个动脉瘤的治疗。平均年龄为11.4岁,从一个月到19年不等。男性21人(63.6%),女性12人(36.4%),产生1.75:1的男性:女性比例。26个(70.3%)动脉瘤来自前循环,11个(29.7%)来自后循环。19例(57.5%)患者发生动脉瘤破裂,其中8例(24.2%)被归类为Hunt-HessIV级或V级。5例(15.2%)患者出现动脉瘤复发或再破裂,5例(15.2%)因动脉瘤后遗症死亡。21例患者(63.6%)在上次随访中获得了良好的预后(改良的Rankin量表评分0-2)。系统文献综述产生了48项研究,其中包括1,482个动脉瘤(血管内治疗611个;手术治疗656个;保守治疗215个)。文献中的平均动脉瘤复发率分别为12.7%和3.9%的血管内和手术治疗。分别。
结论:我们的研究提供了在单一机构接受IAs治疗的儿童的自然史和纵向结果的数据,除了我们对各种动脉瘤形态的治疗策略。尽管出现破裂的患者比例很高,大多数患者可以获得良好的功能结果。
BACKGROUND: Pediatric intracranial aneurysms (IAs) are rare and have distinct clinical profiles compared to adult IAs. They differ in location, size, morphology, presentation, and treatment strategies. We present our experience with pediatric IAs over an 18-year period using surgical and endovascular treatments and review the literature to identify commonalities in epidemiology, treatment, and outcomes.
METHODS: We identified all patients < 20 years old who underwent treatment for IAs at our institution between 2005 and 2020. Medical records and imaging were examined for demographic, clinical, and operative data. A systematic review was performed to identify studies reporting primary outcomes of surgical and endovascular treatment of pediatric IAs. Demographic information, aneurysm characteristics, treatment strategies, and outcomes were collected.
RESULTS: Thirty-three patients underwent treatment for 37 aneurysms over 18 years. The mean age was 11.4 years, ranging from one month to 19 years. There were 21 males (63.6%) and 12 females (36.4%), yielding a male: female ratio of 1.75:1. Twenty-six (70.3%) aneurysms arose from the anterior circulation and 11 (29.7%) arose from the posterior circulation. Aneurysmal rupture occurred in 19 (57.5%) patients, of which 8 (24.2%) were categorized as Hunt-Hess grades IV or V. Aneurysm recurrence or rerupture occurred in five (15.2%) patients, and 5 patients (15.2%) died due to sequelae of their aneurysms. Twenty-one patients (63.6%) had a good outcome (modified Rankin Scale score 0-2) on last follow up. The systematic literature review yielded 48 studies which included 1,482 total aneurysms (611 with endovascular treatment; 656 treated surgically; 215 treated conservatively). Mean aneurysm recurrence rates in the literature were 12.7% and 3.9% for endovascular and surgical treatment, respectively.
CONCLUSIONS: Our study provides data on the natural history and longitudinal outcomes for children treated for IAs at a single institution, in addition to our treatment strategies for various aneurysmal morphologies. Despite the high proportion of patients presenting with rupture, good functional outcomes can be achieved for most patients.