Journal of Pediatric Neuroradiology - Volume 2, issue 3

Authors: Abruzzo, Todd A.

Article Type: Other

DOI: 10.3233/PNR-13069

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 181-187, 2013

Authors: Keenan, Kevin | Hetts, Steven W.

Article Type: Review Article

Abstract: Pial nongalenic arteriovenous fistulas are rare vascular lesions of the brain. The recent decades have brought a new understanding of the origins and associations of these fistulas as well as improvements in diagnosis and treatment. Pediatric patients with nongalenic arteriovenous fistulas are increasingly likely to have good clinical outcomes except in the most complex cases. Recent advances and areas for further investigation will be reviewed.

Keywords: Pial nongalenic AVF, nongalenic pial AVF, NGAVF, AVM

DOI: 10.3233/PNR-13068

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 189-202, 2013

Authors: Abruzzo, Todd A. | DiNapoli, Vincent | Rahme, Ralph | Patel, Biraj | O’Brien, Kevin | Jimenez, Lincoln | Shivashankar, Ravishankar | L. Leach, James | Bissler, John J. | Jones, Blaise

Article Type: Research Article

Abstract: Intracranial arterial aneurysms are an important cause of hemorrhagic stroke during the first two decades of life. In the pediatric population, intracranial arterial aneurysms have a diverse etiological spectrum. The clinical course, response to treatment and long-term prognosis correlate strongly with the mechanism of lesion pathogenesis. A variety of phenotypes have been characterized, having variably overlapping features and differentiated according to the mechanism of pathogenesis: (1) idiopathic, (2) traumatic, (3) infectious, (4) flow related, (5) oncotic, (6) non-infectious inflammatory, (7) arteriopathic and (8) familial. The purpose of this report is to review intracranial aneurysmal disease in the pediatric population. We …discuss contemporary approaches to diagnostic evaluation and clinical management, emphasizing interventional strategies and recent advances. Show more

Keywords: Intracranial aneurysm, cerebral arterial diseases, arteriopathy, children

DOI: 10.3233/PNR-13070

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 203-235, 2013

Authors: Abruzzo, Todd A. | Jimenez, Lincoln | Ostling, Lauren | Stevenson, Charles | Shivashankar, Ravishankar | Leach, James L. | Jones, Blaise

Article Type: Research Article

Abstract: The vein of Galen malformations are a heterogeneous group of developmental arteriovenous shunt lesions characterized by arterialization of the early embryonic choroidal venous circulation. The arteriovenous shunt lesion manifests a spectrum of age dependent clinical phenotypes each of which expresses a wide range of disease severity. Clinical presentation is determined by lesion specific, host specific and environmental factors. In recent years, patient oriented treatment strategies directed at optimizing cardiovascular and neurodevelopmental outcomes have evolved. Treatment is tailored to address specific clinical phenotypes that are differentiated according to their pathophysiology. This paper will review current approaches to the diagnosis and treatment …of vein of Galen malformations patients emphasizing clinical phenotypes of the fetus, neonate and infant. Show more

Keywords: Vascular malformations, vein of Galen malformations, therapeutic embolization

DOI: 10.3233/PNR-13063

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 237-261, 2013

Authors: Gross, Bradley A. | Akgoz, Ayca | Orbach, Darren B.

Article Type: Research Article

Abstract: Dural arteriovenous shunts (dAVF) in children can be classified as dural sinus malformations, infantile dural arteriovenous shunts, and adult-type dural arteriovenous shunts. All subtypes can result in neurologic morbidity as a result of venous or intracranial hypertension and its sequelae. Prognostication and appropriate management is incumbent depends upon understanding both the subtype of dural arteriovenous shunt and its relevant anatomy. When treatment is indicated, endovascular embolization is the mainstay. Surgical treatment may be used adjunctively, though its primary indication is for adult-type dAVF with direct leptomeningeal venous drainage, which cannot be easily accessed by endovascular means. Although radiosurgery has been …used successfully in adults with dAVF, its utility for pediatric patients remains largely unexplored. Show more

Keywords: Dural arteriovenous shunts, pediatric, dural sinus malformation, embolization

DOI: 10.3233/PNR-13064

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 263-268, 2013

Authors: Akgoz, Ayca | Gross, Bradley A. | Lehman, Laura L. | Rivkin, Michael J. | Orbach, Darren B.

Article Type: Research Article

Abstract: The assessment and interventional management of pediatric arterial ischemic stroke (AIS) in the acute setting is a challenge, given the lack of safety and efficacy data on available treatment options and the absence of detailed guidelines specific for children. Endovascular therapy in pediatric AIS must be considered experimental and approached cautiously in order to minimize adverse outcomes, as there are no published studies or prospective clinical trials investigating the safety and efficacy of intra-arterial thrombolysis or mechanical thrombectomy in the management of pediatric AIS. Additional complicating factors include typically increased delays and increased challenge to appropriate diagnosis in children relative …to adults, and underlying differences in the pathophysiology of AIS, the thrombotic cascade, and the natural history of AIS in children. Judicious extrapolation of adult data might be used for treatment of these cases with a highly individualized approach at high-volume centers, by a neurointerventional team in close collaboration with pediatric stroke neurologists. Mechanical approaches may be a safe and potentially effective therapeutic option. Show more

Keywords: Acute ischemic stroke, children, intra-arterial thrombolysis, thrombectomy, hemorrhagic conversion

DOI: 10.3233/PNR-13065

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 269-275, 2013

Authors: Shakur, Sophia F. | Lee, Seon-Kyu

Article Type: Research Article

Abstract: Pial arteriovenous malformations (AVMs) of the brain are vascular abnormalities located in the subpial space that consist of direct communications from artery to vein via intervening nidus. AVMs are the most common intracranial pathology and frequent cause of intracranial hemorrhage in children. Moreover, the epidemiology and clinical findings particular to children with AVMs can be ascribed to the distinct angioarchitecture of pediatric AVMs. However, the natural history and treatment of pediatric AVMs is relatively unknown. In this article, we review current knowledge of pediatric pial AVMs.

Keywords: Pediatric, arteriovenous malformation, natural history, treatment

DOI: 10.3233/PNR-13066

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 277-281, 2013

Authors: Moftakhar, Parham | Hetts, Steven W.

Article Type: Research Article

Abstract: Spinal vascular malformations in children differ in several ways from those found in adults. Genetic syndromes are more common in the pediatric population. Onset of symptoms and clinical presentation is often more acute than in adults. Angioarchitecture of the various spinal vascular malformations differs from adults, with relative overrepresentation of perimedullary arteriovenous fistulas and nidal arteriovenous malformations and a dearth of dural fistulas. Fortunately, excellent results can often be obtained with endovascular or surgical intervention. This review will briefly examine the anatomy, genetics, clinical presentation, imaging, treatment, and outcomes of spinal vascular malformations in children.

Keywords: Spinal cord, vascular malformation, pediatric, endovascular

DOI: 10.3233/PNR-13067

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 283-292, 2013

Authors: Watkins, Trevor W. | Heran, Manraj K.S.

Article Type: Research Article

Abstract: Catheter cerebral angiography in the pediatric population remains the ‘gold standard’ diagnostic modality for assessment of a number of neurovascular disorders. Although its use has declined due to advances in noninvasive imaging techniques, its ability to resolve and provide dynamic assessment of small vessels, vascular lesions and arteriovenous shunts/fistulae makes it an invaluable tool in the assessment and treatment planning for a number of cerebrovascular disorders. A number of subtle and significant differences exist between pediatric and adult cerebral catheter angiography, including methods of vascular access, catheter selection, contrast administration, and sedation requirements. Similarly, the indications for cerebral angiography are …more varied compared with adults. Understanding the differences between pediatric and adult cerebral catheter angiography is essential to ensure safe and appropriate use of the investigation, and to minimize the associated risks. The selective intracarotid administration of sodium amytal (Wada) test is a tool for assessment of language dominance and memory in a select group of patients for preoperative epilepsy surgery planning. In addition to discussing the principles of the test, indications and contraindications, a number of specific issues pertaining to performing the Wada test in the pediatric population will also be addressed. Show more

Keywords: Angiography, cerebral, pediatric, Wada

DOI: 10.3233/PNR-13071

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 3, pp. 293-300, 2013