Pediatric neurovascular disease: surgical, endovascular, and medical management

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For smaller bleeds the symptoms may be simply acute onset of headaches with or without changes in sensorium or function. For larger bleeds, one might expect marked changes in sensorium and function including even coma or profound stupor. In addition to changes in sensorium or function, sometimes these problems can lead to seizures as their first sign of trouble.

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For other types of lesions, such as with the AVMs or Moyamoya you may see a slow change in a childs function over weeks to months. Once a vascular event is suspected an emergency evaluation is required to provide the child with the best chance of successful outcome. If a vascular lesion is found it will usually lead to the child having a study to look at the blood vessels of the brain, known as an angiogram or arteriogram.

The timing of the study is quite dependent on many factors including the probable diagnosis, the childs level of function and the availability of the studies and specialists. In most centers in the US it is not the neurologist or neurosurgeon who performs the study but rather a radiologist.

In addition to having a radiologist and anesthesiologist who are comfortable in treating infants and children with complicated problems, it is quite helpful to have an endovascular neurosurgeon at the center to help in treating the child. The endovascular neurosurgeon is a highly skilled physician who not only can perform the angiogram studies, but when indicated may be able to treat the problem by injecting varying materials in the blood vessels to help stop the source of bleeding.

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This treatment called embolization, may be a permanent cure or it may make it easier for the surgeon to then treat the problem by decreasing the risks of bleeding or stroke during surgery. In addition to surgery and embolization, some vascular lesions may be able to be treated wholly or in part with a type of focused x-rays such as the gamma knife or linear accelerator.

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These x-ray treatments essentially burn away the vascular lesions but unlike the surgical treatments, these treatments require upwards of two years to take maximum effect and may leave a child unprotected from further problems during the time period. While this may not seem desirable, some lesions can not be completely treated with surgery and or embolization and this may represent the best alternative under certain circumstances.

What becomes clear from this discussion, is that for most situations, vascular lesions in children require specialized centers with pediatric and vascular neurosurgeons who have the latest technologies and specialists required to offer a complete evaluation and treatment plan for these rare and often complicated lesions. You have added pages to your clipboard. Please log in or create an account to share them or use later.

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Pediatric neurovascular disease : surgical, endovascular, and medical management

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