Etiology, Presentation, Management, and Outcomes of Intracranial Aneurysms in the Infant Population - an Individual Participant Data Meta-Analysis

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ESPR184
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Background: Intracranial aneurysms are exceedingly rare in infants and can arise from a variety of pathologies. However, given their infrequency, data regarding these lesions remains limited. As a result, the authors performed an individual participant data meta-analysis to evaluate symptomatology, management strategies, and outcomes in this patient population. Objective: The objective of this work is to understand the ways infants with intracranial aneurysms typically present, how they are diagnosed, how they are treated, and which currently implemented practices result in better outcomes for these patients. Design/Methods: Following PRISMA guidelines, a comprehensive literature search of English-language articles from 1980-2020 was performed to identify individual cases of intracranial aneurysms in infants (defined as any patient less than two years of age). Patient demographic information, aneurysm characteristics, presenting symptoms, and management strategies were analyzed. Length of follow-up and Glasgow Outcome Score (GOS) at last follow-up were reported when available. Multivariate linear regression was performed to determine potential predictors of poor neurologic outcome. Results: Individual patient data was obtained for 137 patients from 91 articles. The median age at presentation was 6.49 months and no difference in gender was identified. Only two patients had a family history of aneurysmal subarachnoid hemorrhage. The majority were true aneurysms and occurred spontaneously. Hemorrhage was the most common presentation, followed by seizure and mass effect. Over half of the cases presented with a left-sided aneurysm and mean aneurysmal diameter was 15.1 mm. The most commonly affected vessels were the MCA, ACA and ICA. The most frequently employed management techniques were open surgery and endovascular occlusion. The mean follow-up period was 23.64 months. Two-thirds of patients had a GOS 5 at last follow-up. The mortality rate was 15.73%. On multivariate regression analysis, independent predictors of poor neurological prognosis were hemorrhage at presentation (P = 0.049 univariate; P = 0.041 multivariate), local mass effect (P = 0.003 univariate; P = 0.017 multivariate), infectious etiology (P = 0.031 univariate; P = 0.048 multivariate), decompressive surgery alone (P = 0.01 univariate; P = 0.015 multivariate), longer hospital stay (P = 0.031 univariate), and supportive care without aneurysmal treatment (P = 0.014 univariate; P = 0.017 multivariate). Conclusions: The majority of infantile aneurysms are idiopathic, involve the anterior circulation, and can be successfully treated by surgical or endovascular techniques, leading to neurologic outcomes that compare favorably to adults.

University of Miami Miller School of Medicine

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