Editorial

Abstract

Over the past three decades, a broad range of percutaneous interventions have been made possible. Catheter and wire technologies have advanced, and the refined instruments have been applied to novel purposes. Interventions in children have been complicated by the fact that some of the existing equipment for adults could not be used in children and by a lack of experts with specific knowledge of the children's anatomy, pathology and physiology and adequate training. An intervention in a child is usually a highly stressful experience, which is known to everyone who ever tried to perform such a procedure within a schedule of adult interventional program. Done the right way, interventional radiology procedures are generally less stressful for a child than alternative surgery. The child usually suffers from less pain, needs less nursing care and can leave the hospital earlier. The recovery time is likely to be shorter, too, enabling the child to go back to normal routine. This issue of the European Journal of Radiology covers a broad spectrum of paediatric interventional procedures presented by numerous European and American specialists. Intentionally, it does not include cardiologic or neurointerventional topics because these are specialties covered by paediatric cardiologists and neuroradiologists. Frederic Hoffer from the St. Jude Children's Research Hospital wrote an article about interventional radiology in paediatric oncology. Interventional procedures can be beneficial for these children in terms of diagnosis, prognosis, staging, and the handling of complications of therapy. His article includes descriptions of the relatively new techniques of radiofrequency ablation and chemoembolisation for local tumor control. A contribution about tracheobronchial intervention in children came from the Great Ormond Street Hospital in London. Claire McLaren, Martin Elliott and David Roebuck report about their long and intensive experience with children suffering from various disorders of the major airways. Michael Temple and co-workers from the Hospital of Sick Children in Toronto give an overview about the complexity of medical problems and therapy options in paediatric patients with thrombosis. Rainer Wunsch became an expert in interventional therapy of varicoceles in a German center in which more than 5000 patients underwent this type of therapy. He and his co-author describe retrograde sclerotherapy and alternative methods. There is a number of well-defined diagnostic and therapeutic indications for applying MR-imaging during intervention. Thomas Schulz and his team from the University of Leipzig dispose of broad experience in paediatric MR-guided interventions, which they present in their article. Finally, we tried to give an account of my experience with the percutaneous embolisation of low-flow malformations. My article describes a new technique and focuses on the therapeutic usefulness of ethanol, which is efficient and safe when used by experienced interventionalists, but can be very risky in the hand of an unexperienced radiologist. On this occasion, I would like to mention Professor Francis Brunelle from the Hôpital Enfants Malades–Necker in Paris, who somehow re-discovered ethanol for the therapy of venous and lymphatic malformations and who was and still is a great teacher. There is a central theme in all contributions: the paediatric interventional radiologist is a team player, working side by side with paediatric surgeon, paediatrician, anaesthesiologist and other primary care physicians. It would be beneficial if more centers established this subspeciality in order to improve the medical care of children. Maybe this issue can convince the one or the other to get involved with this interesting and demanding field.