Advances in neurointervention for pediatric neurovascular disease

Abstract

This issue of the Journal of Pediatric Neuroradiology is dedicated to pediatric neurovascular conditions and their interventional management. With some exceptions, this category of pediatric disease is constituted by rare and exotic conditions, which remain obscure and poorly understood entities. Our understanding of these conditions, their pathogenesis, and natural history has improved in recent decades thanks to advances in neuroimaging technologies, epidemiological studies and a steady growth of the literature. Our ever-increasing fund of knowledge in this field is founded on the meticulous observations and records of early pioneers, and their contemporaries, some of who have contributed to this issue. Topics covered in this issue include childhood arterial ischemic stroke, cerebral aneurysms and neurovascular arteriovenous (AV) shunt lesions. Watkins and Heran review the role of diagnostic cerebral angiography in modern clinical neuropediatric practice. They remind us that even in the era of advanced computed tomography and magnetic resonance imaging (MRI), catheter based digital subtraction angiography (DSA) remains an irreplaceable diagnostic tool for the evaluation of numerous pediatric neurovascular conditions including vasculitis, cerebral aneurysms, and vascular malformations of the craniospinal axis. The essential role of catheter based DSA in the diagnostic evaluation of all children with hemorrhagic stroke, and many children with ischemic stroke is emphasized. The authors highlight major technical differences in peri-procedural patient care and catheter technique that are relevant to patients less than 50 kg. Watkins and Heran affirm the noted safety of neuroangiography in children, when performed by experienced specialists. The higher complication rate observed in patients less than 10 kg is addressed, and procedural modifications that have been adapted for this challenging group of patients are discussed. In their review, Watkins and Heran also discuss the continued importance of the Wada test in modern neuropediatric practice. Despite major advances, a number of challenges encountered in children with epilepsy may render functional MRI inadequate for pre-operative lateralization of language and memory. The authors address specific challenges encountered in the pediatric population undergoing Wada testing, and describe techniques they have adapted to address these challenges. Shakur and Lee give a concise update on pial AVmalformations (AVMs) of the brain presenting in childhood. *Address for correspondence: Todd A. Abruzzo, Department of Neurosurgery, 260 Stetson street, suite 2200, Cincinnati, OH 45219, USA. Tel.: +1 513 569 5214; Fax: +1 513 475 8628; E-mail: todd. abruzzo@cchmc.org. Journal of Pediatric Neuroradiology 2 (2013) 181–187 DOI 10.3233/PNR-13069 IOS Press 181