1283 Incidence, Management, and Outcomes of Pediatric Infectious Aneurysms

INTRODUCTION: Mycotic or infectious intracranial aneurysms (IIAs) are a rare complication of systemic infections, resulting from microbial infiltration and degradation of the arterial vessel wall. The majority of infective aneurysms are caused by either Staphylococcus or Streptococcus species and involve the aorta, peripheral, cerebral, and visceral arteries. The suggested mechanisms include embolic occlusion, direct infiltration due to sepsis, or injury due to immune complex deposition. Despite their relatively low frequency (0.5%-6.5%), IIAs are associated with high rates of complications and mortality. METHODS: This is a retrospective study of patients treated for infectious intracranial aneurysms to Children’s Healthcare of Atlanta Hospitals between 01/2007 and 01/2023. Patients were identified through the combined screening of procedure codes and survey of the radiology reports. RESULTS: During the study period, a total of 151 patients were treated for infective endocarditis secondary to congenital or acquired heart disease, of which 13 patients (8.6%) presented with intracranial hemorrhage. Infectious intracranial aneurysms occurred in 5 patients (2.6%) with IE. Infectious aneurysms accounted for 15% of intracranial aneurysms treated during the study period. All patients were screened with non-invasive imaging. CONCLUSIONS: Pediatric IIAs are a rare complication of systemic or local CNS infection in children, with IE as the most common predisposing factor. The key to achieving better outcomes entails a multidisciplinary approach from neurosurgery, neuroradiology, cardiac surgery, and neurocritical care in a timely sensible fashion to deliver individualized treatments on a case-by-case basis. Pediatric patients with ruptured IIAs have high rate of re-rupture and early aneurysm securement should be considered via open or endovascular route when safe options are available.