Pediatric Infectious Aneurysms: Individual Patient Pooled Analysis on Presentation, Management and Outcomes

Saturday, May 4, 2024

2:25 PM – 2:30 PM CT

Location: S401cd

Presenting Author(s)

Andrew Reisner, MD, FACS, FAAP

Neurosurgeon
Emory University
Atlanta, GA, US

Co-Author(s)

AA

Ali Alawieh, MD, PhD

Resident Neurosurgeon
Emory University School of Medicine
Atlanta, Georgia, United States
JA

Jad Assi, MD

Research Assistant
Emory University, United States
Daniel L. Barrow, MD

Neurosurgeon
Emory University School of Medicine
Atlanta, Georgia, United States
BB

Barunashish Brahma, MD

Neurosurgeon
Emory University, United States
CC

C. Michael Cawley, MD

Neurosurgeon
Emory University
Atlanta, Georgia, United States
KC

Katherine E. Chandler

Medical Student
Emory University School of Medicine
JC

Joshua J. Chern, MD, PhD

Neurosurgeon
Children's Healthcare of Atlanta, Emory University School of Medicine
Atlanta, Georgia, United States
Andrew Reisner, MD, FACS, FAAP

Neurosurgeon
Emory University
Atlanta, GA, US
RE

Reem El Annan, MD

Neurosurgeon
Emory University, United States
TG

Tomas Garzon-Muvdi, MD, MSc

Neurosurgeon
Emory University
Dallas, Texas, United States
JG

Jonathan Grossberg, MD

Neurosurgeon
Emory University School of Medicine, Grady Memorial Hospital
Atlanta, Georgia, United States
Brian M. Howard, MD

Neurosurgeon
Emory University School of Medicine
Atlanta, Georgia, United States
gustavo Pradilla, MD

Neurosurgeon
Emory University
Atlanta, Georgia, United States
MS

Michael S. Sawvell, DO

Neurosurgeon
Emory University, United States
Youssef M. Zohdy, MD

Postdoctoral Fellow
Emory University School of Medicine
Alexandria, Egypt

Disclosure(s):

Andrew Reisner, MD, FACS, FAAP: No financial relationships to disclose

Katherine E. Chandler: No financial relationships to disclose

Brian M. Howard, MD: No financial relationships to disclose

Introduction: Infectious intracranial aneurysms (IIAs) are a rare sequela of local or systemic infection and occur most commonly in patients with infective endocarditis (IE). Studies on IIAs in the pediatric population remain limited without clear consensus on optimal management. In this work, we perform a pooled analysis of an individual center and all published series of pediatric patients (age < 18 years) with IIAs to study the disease landscape including presentation, management and outcomes.

Methods: Literature search was performed in MEDLINE/PubMed and SCOPUS for publications in the English literature from 1960 to 2023 on pediatric IIAs. Our search key retrieved a total of 5698 studies, of which 2548 were included based on title and abstract screen. Based on full text review, we identified 76 manuscripts with pooled total of 145 pediatric patients with 178 IIAs. Statistical analysis was performed using GraphPad Prism 9 and IBM SPSS version 28.

Results: The average patient age was 11 (range - newborns to 18). Predisposing factor differed with age; meningitis being the most common < 2 years and IE being the most common > 9 years of age (69%). Un-ruptured IIAs were primarily treated medically only in 55% of cases with subsequent surgical and endovascular treatments in 32.5% and 12.5% of cases, respectively. Among ruptured IIAs, medical management only was employed in 47% of cases with early surgery and endovascular treatments performed in 36% and 12%, respectively. Mortality rate at 90 days was 28% in the full cohort.

Conclusion : Pediatric IIAs remain a rare complication of infections with etiology shifting with age from meningitis in infants to IE in adolescents. Medical management alone failed more commonly in patients with ruptured aneurysms. Endovascular management is an option without reported cases of device-related abscess. These findings argue for early endovascular or microsurgical management in children with ruptured IIAs.