Evaluating the efficacy and safety of flow diverter in pediatric cerebral aneurysm treatment: A systematic review and meta-analysis

Background: Intracranial aneurysms are uncommon in pediatric patients, accounting for less than 5% of all intracranial aneurysms. Despite their rarity, they present notable challenges because of their non-saccular morphology. Given the rising utilization of flow-diverter (FD) devices such as the Pipeline Embolization Device (PED), there's a significant need for a systematic review and meta-analysis to evaluate their applicability for pediatric populations and assess their safety and efficacy. Methods: Medline, Embase, and Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95 % confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with >= 3 patients and focused on outcomes such as immediate and final occlusion, good clinical outcomes, complications, and mortality. Results: The analysis comprised seven studies involving 80 patients with a total of 91 aneurysms. Immediate occlusion was observed in 49 out of 62 cases with a rate of 90 % (95 % CI: 74 % to 100 %). Final occlusion was achieved 71 out of 87 aneurysms a rate of 88 % (95 % CI: 78 % to 98 %). Notably, good clinical outcomes were reported for 59 out of 67 patients, representing a rate of 92 % (95 % CI: 83 % to 100 %). Complications occurred in 5 out of 73 patients, with an incidence rate of 3 % (95 % CI: 0 % to11 %). The total mortality analysis revealed that 5 out of 72 patients died, resulting in a rate of 6 % (95 % CI: 0 % to 12 %). However, when examining mortality related to the FD, no patients died, resulting in a mortality rate of 0 % (95 % CI: 0 % to 3 %). Conclusion: Our systematic review and meta-analysis reveal promising outcomes for FD treatment in pediatric intracranial aneurysms. We observed high occlusion rates and favorable clinical results, suggesting that the technique is safe and effective in the short term. However, further studies are necessary to validate and expand upon these findings.