Pediatric neurovascular disease: surgical, endovascular, and medical management
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Since these lesions involve the blood supply to the brain, when they become apparent can be very striking. This is to say that the symptoms do not come on gradually but rather abruptly.
Certainly if a vascular lesion was to bleed or stop blood to an area of the brain the symptoms would be quite rapid. 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.
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.
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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. 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. 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.ipdwew0030atl2.public.registeredsite.com/362050-telegram-tracking.php
Neurovascular Treatments and Procedures – Penn Medicine
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.
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Facebook Twitter Pinterest Share. Description With contributions from leading authorities in the field, this book reviews the latest multi-modal techniques for managing pediatric neurovascular disease, disorders, and malformations. It covers cerebral aneurysms, arteriovenous fistulas, arteriovenous malformations, vein of Galen malformations, Moyamoya disease, spinal vascular malformations, pediatric stroke, thrombolysis, and more!
Pediatric Neurovascular Disease
Hundreds of illustrations and radiological images; and an easy-to-follow organization of disease topics according to endovascular, surgical, or medical treatment method; makes this book an exceptional clinical reference. The text also includes discussions of endovascular techniques and tools for angioplasty and stents in children, as well as possible complications such as stroke and hemorrhage. Ideal for neurosurgeons, neuroradiologists, neurointerventionalists, neurologists, and pediatricians seeking to gain expertise in a multi-pronged approach to pediatric neurovascular disease.
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