Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
Department of Neurosurgery, Peking University International Hospital, Beijing, China.
Acta Neurochir (Wien). 2024 Oct 15;166(1):412. doi: 10.1007/s00701-024-06306-5.
Pediatric patients with intracranial aneurysms face high risks of spontaneous subarachnoid hemorrhages. Despite its approval for adults aged 22 and above, the Pipeline Embolization Device (PED, Covidien/Medtronic, Irvine, California, USA) is being considered for younger patients due to its efficacy. This study aims to assess the safety and effectiveness of using PEDs in pediatric aneurysm treatment.
A retrospective study across 14 institutions identified 25 patients (age ≤ 18) treated with PED from November 2014 to October 2019. A literature review included all published pediatric aneurysm cases treated with PED from 2007 to 2023. Analyzed data included patient demographics, aneurysm characteristics, treatment, clinical outcomes, and complications.
We analyzed 81 pediatric patients, including 25 from the multi-center registry and 56 from 38 relevant literature. In the entire cohort of 81 patients, mean age of the patients was 11.9 ± 4.0 years (ranged from 9 months to 18 years), with 58.0% males. Ruptured aneurysms were observed in 7 patients (8.6%), whereas 43 patients (53.1%) harbored large/giant aneurysms. The aneurysm occlusion rate was 87.7% during the median 7 months follow-up. Complications occurred in 12.3% of patients, resulting in morbidity in 5 cases (6.1%) and mortality in 4 cases (4.9%). Patient age was not associated with the occurrence of aneurysm residual, complications, and mortality following PED treatment.
PED can be effective for pediatric aneurysms, but morbidity and mortality can be substantial compared to the adults. Surgical timing should depend on clinical judgment and patient factors, without age-related delays.
颅内动脉瘤患儿有较高的自发性蛛网膜下腔出血风险。尽管 Pipeline 栓塞装置（PED，Covidien/Medtronic，加利福尼亚州欧文，美国）已批准用于 22 岁及以上的成人，但由于其疗效，也在考虑用于年龄较小的患者。本研究旨在评估 PED 在儿科动脉瘤治疗中的安全性和有效性。
在 14 家机构进行的回顾性研究中，共纳入 25 例（年龄≤18 岁）自 2014 年 11 月至 2019 年 10 月接受 PED 治疗的患者。文献回顾包括自 2007 年至 2023 年期间所有用 PED 治疗的儿科动脉瘤病例。分析的数据包括患者人口统计学特征、动脉瘤特征、治疗、临床结局和并发症。
我们分析了 81 例儿科患者，其中 25 例来自多中心登记研究，56 例来自 38 篇相关文献。在整个 81 例患者队列中，患者的平均年龄为 11.9±4.0 岁（范围为 9 个月至 18 岁），男性占 58.0%。7 例（8.6%）为破裂性动脉瘤，43 例（53.1%）为大/巨大动脉瘤。中位 7 个月的随访中，动脉瘤闭塞率为 87.7%。12.3%的患者发生并发症，导致 5 例（6.1%）患者出现病残，4 例（4.9%）患者死亡。患者年龄与 PED 治疗后动脉瘤残留、并发症和死亡率的发生无关。
PED 对儿科动脉瘤有效，但与成人相比，发病率和死亡率可能较高。手术时机应根据临床判断和患者因素而定，不应因年龄相关而延迟。
