Department of Neurosurgery, La Pitié-Salpétrière Hospital, Université Paris Sorbonne, Paris, France;
Departments of Pediatric Neurosurgery and.
Pediatrics. 2019 Jun;143(6). doi: 10.1542/peds.2018-3036. Epub 2019 May 8.
Our aim was to report the long-term clinical and imaging outcomes of ≤15-year-old children treated for ruptured or symptomatic cerebral aneurysms and to identify prognostic factors for clinical outcome, recurrence, and rebleeding.
We retrospectively identified all pediatric cases of cerebral aneurysm from 2000 to 2015 and then prospectively evaluated long-term occlusion using brain MRI and clinical outcome measures: outcome was considered favorable if King's Outcome Scale for Childhood Head Injury score was ≥5. We performed univariate analysis and logistic binary regression to identify variables associated with clinical and imaging outcomes.
Fifty-one children (aged 8.5 ± 1.1 years [mean ± SD], with 37 ruptured and 14 symptomatic aneurysms) were included, and endovascular treatments (84%) or microsurgical procedures (16%) were performed. Despite a 19.6% death rate, at a mean follow-up of 8.3 years, 35 children (68.6%) had a favorable outcome. Annual bleeding and aneurysm recurrence rates were 1.4% ± 1.1% and 2.6% ± 1.8%, respectively. Cerebral ischemia, whether initial or delayed within the first month, was predictive of poor clinical outcome in multivariate analysis (odds ratio: 25; 95% confidence interval: 0.43-143; < .0001), whereas aneurysm size >5 mm was the only factor associated with recurrence (odds ratio: 14.6; 95% confidence interval: 2.4-86.1; = .003).
Two-thirds of studied ≤15-year-old children suffering from ruptured or symptomatic cerebral aneurysms had long-term favorable outcome. Annual bleeding and aneurysm recurrence rates have shown to be low after endovascular or surgical treatment. Long-term imaging follow-up helps to depict aneurysm recurrence or de novo aneurysm formation and to prevent rebleeding.
本研究旨在报告≤15 岁儿童破裂或有症状性脑动脉瘤的长期临床和影像学结果，并确定与临床结局、复发和再出血相关的预后因素。
我们回顾性地确定了 2000 年至 2015 年所有儿童脑动脉瘤病例，并前瞻性地使用脑 MRI 和临床结局评估长期闭塞情况：如果儿童头部外伤 King 量表评分≥5 分，则认为结局良好。我们进行了单因素分析和逻辑二元回归分析，以确定与临床和影像学结果相关的变量。
51 例患儿（年龄 8.5±1.1 岁，37 例破裂性动脉瘤，14 例症状性动脉瘤）纳入研究，其中 84%接受了血管内治疗，16%接受了显微手术治疗。尽管死亡率为 19.6%，但在平均 8.3 年的随访中，35 例患儿（68.6%）结局良好。每年出血和动脉瘤复发率分别为 1.4%±1.1%和 2.6%±1.8%。多因素分析显示，脑缺血（无论是初始的还是在第一个月内延迟发生的）是不良临床结局的预测因素（比值比：25；95%置信区间：0.43-143；<0.0001），而动脉瘤大小>5mm 是与复发相关的唯一因素（比值比：14.6；95%置信区间：2.4-86.1；=0.003）。
研究中≥15 岁的 2/3 破裂或有症状性脑动脉瘤患儿有长期良好结局。血管内或手术治疗后，每年出血和动脉瘤复发率较低。长期影像学随访有助于描绘动脉瘤复发或新发动脉瘤形成，并预防再出血。
