Interventional neuroradiology in children

Interventional neuroradiology in children deals with all pathologies involving the head and neck in children. Indeed, the risk in dealing with such pathologies, is quite the same as collaterals between the extra cranial arteries and the intracranial circulation are numerous.

EXTRACRANIAL PATHOLOGIES

Vascular tumours in children are frequent. Haemangiomas do not need to be embolised as, for most of them spontaneous regression is the rule. Embolisation should be reserved to treat complications such as cardiac insufficiency, palpebral occlusion in newborns. The rule of thumb is to know the natural history of vascular malformations in children to precisely adapt the therapeutic to each specific case. Juvenile angiofibroma need to be embolised preoperatively to reduce blood loss during surgery. Ocular complications is a permanent risk and should be avoided. A complete knowledge of anastomoses with the ophthalmic territory is mandatory.

A CT angiograpy should be performed prior all surgical approac of cystic lesions of the jaw, as they may well be arterio-venous fistulas.

Traumatic lesion are some indication for embolisation in emergency.

Venous and lymphatic malformations are treated by a percutaneous approach. They do not represent stricto sensu neurological pathologies .

INTRACRANIAL PATHOLOGIES.

The care of brain vascular malformations has complety changed since the advent of ANGIO MRI and 3D CT; It was the rule to do an angiography on emergency in every child presenting on emergency with an intracranial haematoma; Nowadays, the care depends on the clinical status of the child. If the child presents with a vital risk, an emergency surgical intervention is decided. If the clinical status allows, a complete wok up is performed by CT and MRI. Treatment is decided on the view of this work up. Surgery is done if the malformation is small and superficial. Embolisation is done if the malformation is deep and large. Stereotactic radiotherapy is done as a complement in case of a small residual lesion less than 3cm in diameter. With such a protocole cure is obtained in 85% of the cases.

Specific treatment is adapted in case of vein of Galen aneurysm and dural fistulas.

Antenatal diagnosis of the later condition is now possible. The therapeutic attitude has changed has pregnancy interruption is possible in France.

Lernziele:

Emergency angiograpy has been replaced by 3D CT and MRI. Therapeutic decision is the result of a deep knowledge of the natural history of vascular malformation and evaluation of other available therapeutic possibilities. Such procedures should be discussed and performed in a paediatric environnement with paediatric neurologists, neurosurgeons and neuro anaesthesiologists.

Korrespondierender Autor: Brunelle F

CHU Necker – Université: Paris V, Hôpital Necker-Enfants Malades – Service de Radiologie, 149, rue de Sèvres, 75730 Paris Cedex 15, Paris

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