Cerebral aneurysms in the pediatric population are rare and optimal treatment strategies are not as well characterized as in adults. The Pipeline embolization device (PED) is an endoluminal flow diverter that is commonly used to treat aneurysms in adults, but experience with this device in children is limited. The authors sought to further characterize PED use and outcomes in this specific population by performing both a systematic review of patient-level data from studies reporting the use of the PED to treat pediatric aneurysms and a retrospective review of their experience.

A systematic review of the PubMed, Embase, and Scopus databases was performed to identify studies reporting the use of the PED in pediatric patients (age ≤ 18 years). Disaggregated data regarding demographics, aneurysm characteristics, treatment, and outcomes were collected. Retrospective data from the authors’ two institutions were also included.

Thirty studies comprising patient-level data on 43 pediatric patients with 47 aneurysms were identified. An additional 9 patients with 9 aneurysms were included from the authors' institutions for a total of 52 patients with 56 aneurysms. The mean patient age was 11.1 years. Presentations included aneurysm rupture (17.3%) and symptomatic mass effect (23.1%). Aneurysms were located in the anterior circulation in 55.4% of cases, and 73.2% were described as nonsaccular. Imaging follow-up was available for 89.3% with a mean follow-up of 13.3 months. Aneurysm occlusion was reported in 75%, with 1 case each (1.8%) demonstrating significant in-stent stenosis and parent vessel occlusion. Clinical follow-up was reported in 90.4% with a mean follow-up of 14.7 months. Good functional outcomes (modified Rankin Scale score of 0–1 or Glasgow Outcome Scale score of 5) were reported in 65.4% of the total population. Two major complications were reported, including 1 death.

Despite substantial differences in aneurysm location and type between published pediatric and adult patient populations treated with the PED, the use of the PED in the pediatric population appears to be safe. While the short-term effectiveness is also similar to that of adults, additional studies are needed to further characterize the long-term outcomes and better define the use of this device in pediatric patients.

儿科人群中的脑动脉瘤很少见，最佳治疗策略的特征不如成人。管道栓塞装置 (PED) 是一种腔内分流器，常用于治疗成人动脉瘤，但在儿童中使用该装置的经验有限。作者试图通过对报告使用 PED 治疗小儿动脉瘤的研究中的患者水平数据进行系统审查，并对其经验进行回顾性审查，以进一步描述 PED 在该特定人群中的使用和结果。

对 PubMed、Embase 和 Scopus 数据库进行了系统评价，以确定报告在儿科患者（年龄 ≤ 18 岁）中使用 PED 的研究。收集了关于人口统计学、动脉瘤特征、治疗和结果的分类数据。还包括来自作者的两个机构的回顾性数据。

确定了 30 项研究，其中包括 43 名患有 47 个动脉瘤的儿科患者的患者水平数据。来自作者机构的另外 9 名有 9 个动脉瘤的患者包括在内，总共有 52 名有 56 个动脉瘤的患者。患者的平均年龄为 11.1 岁。表现包括动脉瘤破裂 (17.3%) 和有症状的占位效应 (23.1%)。55.4% 的动脉瘤位于前循环，73.2% 的动脉瘤被描述为非囊状。89.3% 的影像随访可用，平均随访时间为 13.3 个月。75% 的患者报告了动脉瘤闭塞，其中 1 例 (1.8%) 显示出明显的支架内狭窄和载瘤血管闭塞。临床随访率为 90.4%，平均随访时间为 14.7 个月。总人口的 65.4% 报告了良好的功能结果（改良的 Rankin 量表评分为 0-1 分或格拉斯哥结局量表评分为 5 分）。报告了两种主要并发症，包括 1 例死亡。

尽管已发表的使用 PED 治疗的儿科和成人患者人群的动脉瘤位置和类型存在显着差异，但在儿科人群中使用 PED 似乎是安全的。虽然短期有效性也与成人相似，但需要更多研究来进一步表征长期结果并更好地定义该设备在儿科患者中的使用。