Ruptured intracranial arterial aneurysms of children and adolescents. Surgical and total management results.

Sixteen children and adolescents under 20 years of age were treated at the Neurosurgical Department of Helsinki University Central Hospital between 1977 and 1986. These children represent 1.2% of the total 1,346 patients with aneurysm. Fourteen patients with Hunt and Hess grades I-III were operated on without surgical mortality or morbidity. Eight aneurysms were at the carotid bifurcation and six at the anterior communicating artery. One patient was grade IV and one grade V. Both died before operation. The hospital management mortality was 2 out of 16 or 12.5%. Seven patients of that age group within our area of responsibility died of a ruptured aneurysm during the years before patients were referred for neurosurgical treatment. Thus, the total mortality was 9 of 23 patients or 39%. Assuming transfer without delay to the neurosurgical clinic, operation within the first few days of bleeding, and no surgical mortality, the theoretical minimum mortality would be 22%.