Abstract
INTRODUCTION:Giant pediatric aneurysms are vascular malformations that can cause significant neurologic morbidity and mortality. Their rarity has precluded large cohort studies to inform their management.METHODS:Multi-institutional cohort study of cases from Boston Children's Hospital (BCH) and the Barrow Neurologic Institute (BNI) along with systematic review and meta-analysis of previously reported cases.RESULTS:A total of 15 patients were included in the multi-institutional cohort, and an additional 88 patients were included from 14 series to yield 103 patients within the meta-analysis. Amongst the BCH patients, male sex was associated with giant size (OR .2; 95% CI 1.2-162.0).The most common aneurysm locations were in the MCA (38%), ICA (25%), vertebral artery (VA; 11%), and VBJ (8%). Within 69 reports containing radiographic data within the meta-analysis, 38% of aneurysms were saccular. Twenty-eight cases presented with rupture (28%). 0% of cavernous ICA aneurysms, 26% of other anterior circulation aneurysms, and 44% of posterior circulation aneurysms presented with rupture. Increasing age (OR 1.2; 95% CI 1.0-1.4) and saccular morphology (OR 5.3, 95% CI 1.5-18.9) were associated with presentation with rupture, while posterior location trended towards an association (OR 3.1, 95% CI 0.9-11.0). The majority of cases in the systematic review were treated (97%) rather than observed (3%). Endovascular and open treatments were utilized in 40 and 56% of cases. Survival was 97% for unruptured aneurysms and 82% for ruptured aneurysms. A favorable neurologic outcome occurred in 80% of unruptured cases and 54% of ruptured cases. Unruptured presentation (OR 3.7, 95% CI 1.3-11.1) and endovascular treatment modality were associated with a favorable outcome (OR 5.0; 95% CI 1.6-15.8).CONCLUSIONS:Giant pediatric aneurysms are unlikely to be discovered incidentally and often merit treatment. Increasing age and saccular morphology are r predict rupture, and should elevate the concern for semi-urgent treatment.