Pediatric cerebral aneurysms: long-term outcomes from a single-center case series and a narrative review of the contemporary literature.

backgroundPediatric intracranial aneurysms (PIAs) are rare and present with distinct clinical and morphological features compared to adult cases. They are often associated with congenital anomalies, larger size, and unusual locations. Despite advancements in diagnosis and treatment, data about PIAs remain scarce. This study presents a 20-year single center experience in the management of PIAs, alongside a comprehensive literature review.

methodsA retrospective review of pediatric patients diagnosed with intracranial aneurysms at a tertiary center between January 2005 and January 2025. Demographic, clinical, radiological, and treatment data were collected. Functional outcomes were assessed using the Glasgow Outcome Scale (GOS). Descriptive statistics, chi-square tests were used for analysis. A narrative literature review was also performed.

results38 patients with 61 aneurysms were included (63.2% male; mean age 12.3 years). Index aneurysm for each patient was included in the analysis of location and size. Most aneurysms were located in the anterior circulation, particularly the ICA bifurcation (34.2%) and MCA (23.7%). Ruptured aneurysms seen in 73.7% of cases, 44.7% presenting with Fisher grade 4 hemorrhage. Treatment microsurgical clipping (50%), endovascular therapy (36.8%), and conservative management (7.9%). There was no statistically significant association between treatment modality and outcome (p = 0.153). Good functional recovery (GOS 5) achieved in 60.5% of patients; with a mortality rate of 13.2%.

conclusionsPIAs frequently present with rupture and require individualized, multidisciplinary management. Both surgical and endovascular approaches are effective in selected patients, with comparable outcomes. Our findings align with global literature and reinforce the need for early diagnosis, tailored intervention, and long-term follow-up in this unique population.