Operative Neurosurgery 29:27–33, 2025
This retrospective study reviews five pediatric cases of infectious intracranial aneurysms (IIAs) secondary to infective endocarditis. IIAs in children are rare but have high morbidity and mortality, with early surgical or endovascular intervention recommended due to frequent failure of medical management and high rerupture rates.
• Pediatric infectious intracranial aneurysms (IIAs) are rare complications, most often secondary to infective endocarditis (IE), and account for 2–14% of pediatric intracranial aneurysms.
• This retrospective study identified 5 pediatric cases of IIA among 151 children treated for IE (3%), with most patients having congenital or acquired heart disease.
• The majority (80%) presented with ruptured aneurysms causing subarachnoid hemorrhage (SAH); one was found incidentally.
• All patients were started on antibiotics, but 80% failed medical management and required surgical or endovascular intervention.
• Mortality was high: 2 of 5 patients (40%) died within a year, and only 2 survivors had good neurological outcomes (mRS <2).
• Early intervention (surgical or endovascular) is recommended for ruptured IIAs due to high rates of rerupture and medical management failure.
• A multidisciplinary approach is essential for optimal outcomes in these complex cases.
• Further studies with larger cohorts are needed to determine the best management strategies.
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