Background: Intracranial mycotic aneurysms (IMAs) in pediatric patients are rare, high-risk vascular lesions with heterogeneous presentations that require individualized management. This study aims to review the current literature on pediatric IMAs. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was registered with the International Prospective Register of Systematic Reviews (CRD420251232302). Eligible studies included image-confirmed pediatric IMAs in patients ≤18 years, with reported management details and clinical outcomes. The data was extracted using a standardized form, and the study quality was evaluated using the established grading criteria. Results: Most patients presented acutely, with noncontrast computed tomography serving as the initial imaging modality in 66.7% of cases. Favorable outcomes were reported in 61.1% of patients managed medically, 66.7% of those undergoing endovascular therapy, and 71.4% of those treated surgically. Complete occlusion was achieved in 50.0% of medically managed cases, compared with 100% following endovascular treatment and 81.8% after surgery. Overall, the included studies were classified as Class III evidence. Conclusion: Pediatric IMAs frequently present acutely, often in association with infective endocarditis, and require prompt evaluation. Although antimicrobial therapy remains fundamental, endovascular and open surgical approaches have been associated with more consistent aneurysm exclusion. Improved surveillance and management will depend on standardized reporting and the development of multicenter registries.
Alhafez et al. (Fri,) studied this question.