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Risk factors for intracranial aneurysm rupture in pediatric patients

  • Original Article - Pediatric Neurosurgery
  • Published:
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Abstract

Background

Intracranial aneurysm (IA) rupture in pediatric patients is a rare but fatal condition. Although risk factors for aneurysm rupture in adults have been well documented, they remain unknown in pediatric patients.

Methods

Data for 94 pediatric patients with IAs were retrospectively analyzed. The patients were divided into ruptured and unruptured groups. Risk factors for aneurysm rupture were analyzed through univariable and multiple logistic regression analyses. Typical patients with risk factors were described.

Results

Univariable analyses showed that the unruptured group had significantly higher percentages of giant aneurysms (43.2% vs 12.3%, P = 0.002), wide-neck aneurysms (67.6% vs 29.8%, P = 0.001), and aneurysms located in the internal carotid artery (40.5% vs 3.5%, P < 0.001), while the ruptured group had significantly higher percentages of patients younger than 5 years old (28.1% vs 5.4%, P = 0.013) and aneurysms located in the anterior cerebral artery (24.6% vs 5.4%, P = 0.032), posterior cerebral artery (14.0% vs 0%, P = 0.045), and distal arterial region (DAR) (46.8% vs 27.0%, P < 0.001). Multiple logistic regression analysis confirmed that age 0–5 years (OR = 6.844, P = 0.042) and IAs located in the DAR (OR = 4.162, P = 0.029) were independently related to an increased risk of rupture. Wide-necked aneurysms (OR = 0.235, P = 0.047) were independently associated with a lower risk of rupture.

Conclusions

Among pediatric patients, age younger than 5 years and lesions located in the DAR are independent risk factors for IA rupture, while an IA with a wide neck acts as a protective factor.

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Abbreviations

IA:

Intracranial aneurysm

DAR:

Arterial region

SAH:

Subarachnoid hemorrhage

ICH:

Intracerebral hemorrhage

IRB:

Institutional review board

GCS:

Glasgow Coma Scale

CT:

Computed tomography

CTA:

Computed tomographic angiography

DSA:

Digital subtraction angiography

MCA:

Middle cerebral artery

ACA:

Anterior cerebral artery

PCA:

Posterior cerebral artery

SD:

Standard deviation

CI:

Confidence interval

ICA:

Internal carotid artery

AVM:

Arteriovenous malformations

ICP:

Intracranial pressure

AR:

Aspect ratio

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Funding

This study was funded by the fellowship of China Postdoctoral Science Foundation (2020M673237), Postdoctoral Science Foundation of West China Hospital (2020HXBH155) Science and Foundation of Department of Science and Technology Sichuan Province (2020YFS0223);

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Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Ruiqi Chen, Si Zhang, Anqi Xiao, Rui Guo & Junpeng Ma

Authors
  1. Ruiqi Chen
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  2. Si Zhang
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  3. Anqi Xiao
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  4. Rui Guo
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  5. Junpeng Ma
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Corresponding author

Correspondence to Junpeng Ma.

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Conflict of interest

The authors declare no competing interests.

Informed consent

Informed consent was obtained from the parents or legal guardians of all individual participants included in the study.

Additional information

Comments

Dr Junpeng Ma and colleagues are acknowledged for their study of risk factors for intracranial aneurysm rupture in pediatric patients. They studied 94 aneurysm patients under 18 years of age selected from 5582 patients managed during a 7-year period in West China Hospital. When ruptured aneurysms (n = 57) and unruptured aneurysms (n = 40) were compared, unruptured aneurysms were more often giant in size, wide-necked and located in ICA, while ruptured aneurysms were more often in younger patients, located in ACA, PCA or peripheral arteries. Multiple regression analysis showed that low age and peripheral location were independent predictors of rupture, while wide-neck was independently associated to low risk of rupture. The findings provide valuable information for the management of pediatric subarachnoid hemorrhage patients.

Per Enblad, M.D., Ph.D.

Uppsala Sweden.

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Chen, R., Zhang, S., Xiao, A. et al. Risk factors for intracranial aneurysm rupture in pediatric patients. Acta Neurochir 164, 1145–1152 (2022). https://doi.org/10.1007/s00701-021-04957-2

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