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Pediatric Neurointerventions
What are pediatric neurovascular disorders?
Neurovascular disease encompasses a broad range of conditions affecting the arteries of the brain, spinal cord or their connecting vessels, typically resulting from structural or functional abnormalities of the blood vessels.
The pattern of neurovascular disorders in children differs from that seen in adults and is considerably less common. Management often requires a multidisciplinary approach involving paediatricians, neurosurgeons, interventional neuroradiologists and other specialists.
Our group specialise in the assessment and treatment of newborns, infants and children with neurovascular conditions affecting the brain, spinal cord and spinal column. We evaluate each case carefully to determine the most appropriate treatment plan based on the diagnosis and the child’s individual circumstances, coordinating care with other clinicians as required.
How are pediatric neurovascular disorders diagnosed?
We provide advanced diagnostic imaging, with particular expertise in paediatric angiography. Paediatric anaesthetists administer sedation for imaging procedures to enhance patient safety. A paediatric neuroradiologist conducts an initial comprehensive assessment for new patients and coordinates the diagnostic work-up.
We evaluate, diagnose and treat the full range of challenging and complex cerebrovascular conditions, including:
- Aneurysms
- Arterial Dissection
- Arteriovenous Fistula (AVF)
- Arteriovenous Malformations (AVM)
- Cavernous Malformation
- Cerebral Venous Sinus Thrombosis
- Intracerebral Hemorrhage
- Moyamoya Disease
- Stroke
- Subarachnoid hemorrhage
- Vein of Galen Malformations
How are pediatric neurovascular disorders treated?
Our centre offers state-of-the-art treatments for cerebrovascular disease, employing a multidisciplinary approach that combines open surgery, minimally invasive endovascular techniques, image-guided therapies, interventional paediatric radiology and pharmacological management as appropriate. Common treatments include:
- Embolization:Delivery of occlusive agents to arrest bleeding or reduce blood flow to vascular malformations, facilitating subsequent treatment or removal.
- Platinum coils:Deployment of fine coils within abnormal vessels to slow or obstruct flow; often used in combination with embolisation when coils alone are insufficient.
- Resection:Surgical excision of venous malformations using image guidance to optimise operative planning and minimise complications.
- Stenting:Placement of intravascular mesh devices to scaffold stenotic arteries and restore luminal patency.
- Endovascular stroke interventions:Mechanical thrombectomy to retrieve obstructive clots and rapidly restore cerebral blood flow.
- Thrombolysis:Pharmacological dissolution of thrombus using approved thrombolytic agents when clinically indicated.
- Revascularization:Procedures to redirect or augment cerebral blood supply to regions affected by reduced perfusion.
Treatment plans are individualised by a multidisciplinary team to match the clinical circumstances and optimise outcomes while minimising risk.
Procedures
Sclerotherapy is a minimally invasive procedure in which a fine needle is used to access a cystic or vascular compartment through the skin. A sclerosing agent—commonly bleomycin or similar agents—is injected into the lesion. The agent provokes a controlled inflammatory response within the lesion, promoting collapse of the abnormal space and subsequent fibrosis. Treatment is typically delivered over multiple sessions, as the therapeutic response and remodelling occur gradually. Prior to proceeding, a comprehensive discussion with the patient is essential to review the planned approach, expected outcomes and potential risks, since management is individualised for each case.
Indications and rationale
Sclerotherapy is used to manage selected vascular malformations of the head and neck. Appropriate case selection is critical because vascular anomalies vary considerably in type, flow characteristics and anatomical location. Assessment commonly includes a focused clinical examination and ultrasound, supplemented by MRI for detailed anatomical characterisation. When there is significant arterial inflow or when angiographic information is required for planning, catheter angiography—sometimes with concurrent embolization—may be performed.
Decision-making includes consideration of:
- lesion type (for example, low-flow versus high-flow malformations);
- lesion extent and anatomical relations;
- previous treatments and response;
- patient preferences and comorbidities.
Our IR team specialises in the diagnosis and treatment of a wide range of neurovascular conditions in paediatric patients, most commonly arteriovenous malformations and complex arteriovenous fistulas affecting the brain and spine. These conditions can present from the neonatal period through adolescence and require individualised assessment and management. We work closely with paediatric neurosurgery and other specialist teams to provide coordinated, multidisciplinary care aimed at achieving the best possible outcomes.
What is a diagnostic cerebral angiogram?
A diagnostic cerebral angiogram, often referred to as digital subtraction angiography (DSA), is the reference standard for detailed evaluation of the brain’s blood vessels. While CT angiography and MR angiography have advanced substantially, they may lack the spatial and temporal resolution required to characterize certain neurovascular conditions. DSA provides high-resolution, dynamic imaging that is frequently necessary to establish a diagnosis and to delineate vascular anatomy for treatment planning.
How is a diagnostic cerebral angiogram performed?
Most diagnostic cerebral angiograms are performed electively on an outpatient basis, although the procedure can be performed during an inpatient admission when clinically indicated. Patients typically receive conscious sedation in addition to local anesthesia at the access site.
Vascular access is most commonly obtained via the common femoral artery in the groin. A catheter is navigated through the arterial system into the cervical and intracranial vessels. An iodine-based contrast agent is injected through the catheter while high-resolution fluoroscopic images are acquired. When indicated, three-dimensional rotational angiography is performed to further delineate complex vascular anatomy.
At the conclusion of the procedure, the catheter is removed and hemostasis is achieved using manual compression or a vascular closure device. Patients are monitored during a short recovery period—typically around four hours—and may be discharged the same day if their condition is stable.
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