Child's Nervous System

, Volume 29, Issue 3, pp 451–456

Pediatric intracranial aneurysms: current national trends in patient management and treatment

  • Rohit Vasan
  • Jaymin Patel
  • J. M. Sweeney
  • Anne Marie Carpenter
  • Katheryne Downes
  • A. Samy Youssef
  • Harry van Loveren
  • Siviero Agazzi
Original Paper

Abstract

Purpose

Pediatric intracranial aneurysms constitute a medical disease process with many unique features that present unique challenges in orchestrating their treatment. Conflicts exist in pediatric aneurysm literature as to whether endovascular therapy is equivalent to surgical therapy in assuring durable aneurysm obliteration in this population.

Materials and methods

The national Healthcare Cost and Utilization Project (HCUP) Kid’s Inpatient Dataset was queried using the HCUPnet system. Overall trends in length of stay (LOS), associated charges, and in-hospital deaths were analyzed for both subarachnoid hemorrhage (SAH) and nonruptured aneurysms from 2000 to 2009. Trends in the type of procedure, associated LOS, and charges were analyzed for SAH from 2003 to 2009. A p value <0.05 was considered statistically significant.

Results

Mean LOS for SAH patients was an additional 7–10 days compared to patients discharged with nonruptured aneurysms. Costs of surgery showed a slight increase, while endovascular procedures also rose 50 % from 2006 to 2009. Interestingly, mean length of stay increased for endovascular procedures from 16.5 to 17.2 days and decreased for surgical procedures from 20.4 to 14.7 days (p < 0.001).

Conclusions

First, in-hospital mortality and hospital length of stay for pediatric subarachnoid hemorrhage have not significantly declined since 1997. Second, in-hospital charges for the management of both ruptured and nonruptured aneurysms rose by over 200 % from 2000 to 2009. Surgical procedures saw a 6 % increase in price, while endovascular procedures sharply rose in costs by 50 %. Finally, endovascular therapy has increased in utilization, while the frequency of surgical therapy has not changed significantly since 2003.

Keywords

Pediatric Aneurysm Endovascular Surgery Trends Procedures Intracranial 

References

  1. 1.
    Andaluz N, Zuccarello M (2008) Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database. J Neurosurg 108:1163–1169PubMedCrossRefGoogle Scholar
  2. 2.
    Anson JA, Lawton MT, Spetzler RF (1996) Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193PubMedCrossRefGoogle Scholar
  3. 3.
    Biondi A, Jean B, Vivas E, Le Jean L, Boch AL, Chiras J, Van Effenterre R (2006) Giant and large peripheral cerebral aneurysms: etiopathologic considerations, endovascular treatment, and long-term follow-up. AJNR Am J Neuroradiol 27:1685–1692PubMedGoogle Scholar
  4. 4.
    Drake CG, Peerless SJ (1997) Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87:141–162PubMedCrossRefGoogle Scholar
  5. 5.
    Eckard DA, O'Boynick PL, McPherson CM, Eckard VR, Han P, Arnold P, Batnitzky S (2000) Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms. AJNR Am J Neuroradiol 21:137–142PubMedGoogle Scholar
  6. 6.
    Fulkerson DH, Voorhies JM, Payner TD, Leipzig TJ, Horner TG, Redelman K, Cohen-Gadol AA (2011) Middle cerebral artery aneurysms in children: case series and review. J Neurosurg Pediatr 8:79–89PubMedCrossRefGoogle Scholar
  7. 7.
    Hetts SW, Narvid J, Sanai N, Lawton MT, Gupta N, Fullerton HJ, Dowd CF, Higashida RT, Halbach VV (2009) Intracranial aneurysms in childhood: 27-year single-institution experience. AJNR Am J Neuroradiol 30:1315–1324PubMedCrossRefGoogle Scholar
  8. 8.
    Huang MC, Baaj AA, Downes K, Youssef AS, Sauvageau E, van Loveren HR, Agazzi S (2011) Paradoxical trends in the management of unruptured cerebral aneurysms in the United States: analysis of nationwide database over a 10-year period. Stroke 42:1730–1735PubMedCrossRefGoogle Scholar
  9. 9.
    Kakarla UK, Beres EJ, Ponce FA, Chang SW, Deshmukh VR, Bambakidis NC, Zabramski JM, Spetzler RF (2010) Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes. Neurosurgery 67:237–249, discussion 250PubMedCrossRefGoogle Scholar
  10. 10.
    Krings T, Geibprasert S, ter Brugge KG (2010) Pathomechanisms and treatment of pediatric aneurysms. Childs Nerv Syst 26:1309–1318PubMedCrossRefGoogle Scholar
  11. 11.
    Liang J, Bao Y, Zhang H, Wrede KH, Zhi X, Li M, Ling F (2009) The clinical features and treatment of pediatric intracranial aneurysm. Childs Nerv Syst 25:317–324PubMedCrossRefGoogle Scholar
  12. 12.
    Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP (2003) Endovascular treatment of peripheral cerebellar artery aneurysms. AJNR Am J Neuroradiol 24:1208–1213PubMedGoogle Scholar
  13. 13.
    Lv X, Jiang C, Li Y, Yang X, Wu Z (2009) Endovascular treatment for pediatric intracranial aneurysms. Neuroradiology 51:749–754PubMedCrossRefGoogle Scholar
  14. 14.
    Nussbaum ES, Madison MT, Myers ME, Goddard J, Janjua T (2008) Dissecting aneurysms of the posterior inferior cerebellar artery: retrospective evaluation of management and extended follow-up review in 6 patients. J Neurosurg 109:23–27PubMedCrossRefGoogle Scholar
  15. 15.
    Sanai N, Quinones-Hinojosa A, Gupta NM, Perry V, Sun PP, Wilson CB, Lawton MT (2006) Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg 104:82–89PubMedGoogle Scholar
  16. 16.
    Sanai N, Auguste KI, Lawton MT (2010) Microsurgical management of pediatric intracranial aneurysms. Childs Nerv Syst 26:1319–1327PubMedCrossRefGoogle Scholar
  17. 17.
    Stiefel MF, Heuer GG, Basil AK, Weigele JB, Sutton LN, Hurst RW, Storm PB (2008) Endovascular and surgical treatment of ruptured cerebral aneurysms in pediatric patients. Neurosurgery 63:859–865, discussion 865–856PubMedCrossRefGoogle Scholar
  18. 18.
    Tso MK, Kochar P, Goyal M, Hudon ME, Morrish WF, Wong JH (2011) Long-term angiographic and clinical outcomes in completely versus incompletely coiled ruptured intracranial aneurysms. Clin Neurosurg 58:143–148PubMedCrossRefGoogle Scholar
  19. 19.
    Yamaura I, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, Matsumoto T (1999) Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90:853–856PubMedCrossRefGoogle Scholar
  20. 20.
    Yang M, Wang S, Zhao Y, Zhao J (2008) Management of intracranial aneurysm in children: clipped and coiled. Childs Nerv Syst 24:1005–1012PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Rohit Vasan
    • 1
  • Jaymin Patel
    • 1
  • J. M. Sweeney
    • 1
  • Anne Marie Carpenter
    • 1
  • Katheryne Downes
    • 1
  • A. Samy Youssef
    • 1
  • Harry van Loveren
    • 1
  • Siviero Agazzi
    • 1
  1. 1.Department of Neurosurgery and Brain Repair, College of MedicineUniversity of South FloridaTampaUSA

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