Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026
Aneurysmal subarachnoid hemorrhage in infants: a case report and systematic review with pooled individual patient-level analysis.
СтатьяСистематический обзорПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Barbarawi Mohamed M, Khateeb Balqees, Abuhashem Omar, AlQato Rama, Saeed Ahmad E, AlQurm Amro K, Abdallah Adam M
Аннотация
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) in infants is exceptionally rare, posing unique diagnostic and therapeutic challenges due to nonspecific clinical features and lack of standardized management protocols.
CASE PRESENTATION: We report a 6-month-old male presenting with vomiting, decreased consciousness, and seizures. Neuroimaging revealed diffuse subarachnoid hemorrhage from a ruptured left middle cerebral artery (MCA) aneurysm. Despite aggressive stabilization, the patient suffered rebleeding and succumbed to catastrophic complications.
METHODS: A systematic review following PRISMA guidelines was conducted (CRD420251145008). PubMed, Embase, and Cochrane CENTRAL were searched (2005-2025) for aSAH cases in infants ≤ 12 months. Extracted individual patient data were combined into a pooled individual-level analysis comparing survival and functional outcomes between intervention (endovascular/microsurgical) and conservative management using Fisher's exact test.
RESULTS: Sixty cases were identified (median age 6 months; 56% male). The MCA was the most frequently affected site (38%). Seizures (42%) and altered consciousness (38%) were common presentations. In the pooled analysis, 43 infants underwent intervention (37% endovascular, 33% microsurgical) while 8 received conservative management. Intervention was associated with a trend toward improved survival (88% vs. 63%; OR 4.50, 95% CI 0.73-28.9, p = 0.11). No significant difference in survival (OR 0.71, p > 0.99) or favorable functional outcome (OR 0.89, p > 0.99) was found between endovascular and microsurgical cohorts.
CONCLUSIONS: Infantile aSAH is a devastating condition requiring early neuroimaging. Quantitative synthesis suggests active intervention may offer a survival advantage over conservative management, with both endovascular and microsurgical approaches demonstrating comparable efficacy in specialized centers.
CASE PRESENTATION: We report a 6-month-old male presenting with vomiting, decreased consciousness, and seizures. Neuroimaging revealed diffuse subarachnoid hemorrhage from a ruptured left middle cerebral artery (MCA) aneurysm. Despite aggressive stabilization, the patient suffered rebleeding and succumbed to catastrophic complications.
METHODS: A systematic review following PRISMA guidelines was conducted (CRD420251145008). PubMed, Embase, and Cochrane CENTRAL were searched (2005-2025) for aSAH cases in infants ≤ 12 months. Extracted individual patient data were combined into a pooled individual-level analysis comparing survival and functional outcomes between intervention (endovascular/microsurgical) and conservative management using Fisher's exact test.
RESULTS: Sixty cases were identified (median age 6 months; 56% male). The MCA was the most frequently affected site (38%). Seizures (42%) and altered consciousness (38%) were common presentations. In the pooled analysis, 43 infants underwent intervention (37% endovascular, 33% microsurgical) while 8 received conservative management. Intervention was associated with a trend toward improved survival (88% vs. 63%; OR 4.50, 95% CI 0.73-28.9, p = 0.11). No significant difference in survival (OR 0.71, p > 0.99) or favorable functional outcome (OR 0.89, p > 0.99) was found between endovascular and microsurgical cohorts.
CONCLUSIONS: Infantile aSAH is a devastating condition requiring early neuroimaging. Quantitative synthesis suggests active intervention may offer a survival advantage over conservative management, with both endovascular and microsurgical approaches demonstrating comparable efficacy in specialized centers.