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Treatment of large infectious extracranial carotid artery pseudoaneurysms in children: a systematic review of the literature

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Abstract

Introduction

Extracranial carotid artery pseudoaneurysm is a rare complication of deep neck space infection, and no evidence-based treatment guidelines are available in the literature.

Method

To clarify the existing experience of the different treatment strategies, the authors performed a systematic literature search using the PubMed, Ovid EMBASE, and Scopus databases in accordance with PRISMA guidelines to review all reported cases of pediatric patients with infectious carotid pseudoaneurysms larger than 1 cm.

Results

Twenty-six patients with a median age of 4 years (range 6 months–15 years) were identified. Eighteen patients (69.2%) were treated with endovascular methods, 6 patients (23.1%) with surgical methods, 1 patient (3.8%) with a hybrid endovascular/surgical approach, and 1 patient (3.8%) with conservative management. Recurrence of the pseudoaneurysm occurred in 2 cases (7.7%), both of which were successfully retreated. Of the 6 patients (23.1%) who presented with pre-procedure neurologic deficits, 3 patients had complete or near complete resolution of symptoms after intervention and 3 patients had persistent deficits at last follow-up. Four patients (15.4%) experienced new neurologic deficits post-procedure that resolved at last follow-up.

Conclusion

The endovascular treatment tends to be the preferred option to treat a large or giant infectious pseudoaneurysm of the carotid artery in the pediatric patient. However, more evidence is necessary to elucidate comparative safety and efficacy profiles of endovascular and surgical management strategies.

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Author notes

  1. Chandrasekhar Sundarrajan and Samya A. Isa contributed equally to this work

Authors and Affiliations

  1. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA

    Chandrasekhar Sundarrajan, Samya A. Isa, James P. Caruso, Vin Shen Ban, Brett A. Whittemore & Rafael Sillero

  2. Division of Pediatric Neurosurgery, Children’s Health, Dallas, TX, 75235, USA

    Brett A. Whittemore & Rafael Sillero

  3. Division of Pediatric Otolaryngology, Children’s Health, Dallas, TX, 75235, USA

    Gopi B. Shah

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  1. Chandrasekhar Sundarrajan
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Contributions

C.S., S.A.I., J.P.C., R.S.: conception of the work. C.S., S.A.I., J.P.C.: acquisition of the data. C.S., S.A.I., J.P.C., V.S.B., G.B.S., B.A.W., R.S.: analysis and interpretation of the data. C.S., S.A.I., J.P.C.: drafting of the work. J.P.C., V.S.B., G.B.S., B.A.W., R.S.: critically revising the work for intellectual content. C.S., S.A.I., J.P.C., V.S.B., G.B.S., B.A.W., and R.S.: gave approval of the final manuscript and agree to be accountable for all aspects of the work.

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Correspondence to Rafael Sillero.

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This work was submitted as an abstract to the 59th Annual UT Southwestern Medical Student Research Forum. February 2, 2021. Dallas, TX.

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Sundarrajan, C., Isa, S.A., Caruso, J.P. et al. Treatment of large infectious extracranial carotid artery pseudoaneurysms in children: a systematic review of the literature. Childs Nerv Syst 37, 1461–1470 (2021). https://doi.org/10.1007/s00381-021-05084-0

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