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Neurointerventional procedures in the pediatric age group
1Hospital for Sick Children, The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada. kterbrugge@torhosp.toronto.on.ca
Insights
Interventional neuroradiology advancements enable safe endovascular therapy for pediatric central nervous system vascular disorders. This minimally invasive approach is crucial for conditions like vein of Galen malformations and dural arteriovenous shunts.
Area of Science:
- Interventional Neuroradiology
- Pediatric Neurology
- Vascular Neurology
Background:
- Significant advancements in interventional neuroradiology over 15 years.
- Miniaturization of devices and improved embolic materials enhance safety.
- Increasing inclusion in pediatric central nervous system (CNS) vascular disorder management.
Purpose of the Study:
- To review the established and evolving role of endovascular therapy in pediatric CNS vascular disorders.
- To highlight the safety and efficacy of endovascular techniques in neonates, infants, and children.
- To discuss the integration of endovascular specialists into multidisciplinary care teams.
Main Methods:
- Review of current literature and clinical practice in pediatric interventional neuroradiology.
- Analysis of the application of endovascular techniques for specific pediatric vascular lesions.
- Discussion of the multidisciplinary team approach in managing complex cases.
Main Results:
- Established role of endovascular therapy for vein of Galen malformations and dural arteriovenous shunts.
- Growing importance in managing brain and spinal arteriovenous malformations.
- Rapidly evolving applications for pediatric intracranial aneurysms and acute ischemic stroke.
Conclusions:
- Endovascular therapy is a safe and effective modality for pediatric CNS vascular disorders.
- The role of interventional neuroradiology is expanding, particularly within multidisciplinary teams.
- Future growth anticipated in managing complex pediatric neurovascular diseases.
Abstract:
Over the past 15 years there have been significant changes in the field of interventional neuroradiology, which have led to the inclusion of this specialty in the management of pediatric patients with vascular disorders of the central nervous system. Miniaturization of the devices and improvements in the embolic materials used have made it possible to perform endovascular therapy safely on neonates, infants and children. The role of endovascular therapy in the management of patients presenting with vein of Galen malformations and dural arteriovenous shunts has become clearly established. Endovascular therapists have also become important members of multidisciplinary teams managing patients with arteriovenous malformations of the brain and spinal cord. The role of endovascular therapy in the management of children with intracranial aneurysms is rapidly evolving, and experience with thrombolytic intra-arterial therapy for acute ischemic stroke is just gaining momentum. It is anticipated that in the future the role of endovascular therapy will continue to grow as part of the multidisciplinary team approach to the management of children presenting with complex vascular diseases of the central nervous system.