Pediatric Vascular Conditions
Many rare problems can affect blood vessels in the brains of newborns, infants, and growing children. Such problems are potentially serious and can be frightening—but most of them can be treated successfully. In taking care of children with vascular conditions, the surgical therapies we most frequently turn to are embolization (a minimally invasive procedure), Gamma Knife radiosurgery (a precise method of delivering radiation) and forms of traditional surgery specifically tailored for each condition.
At Columbia, our treatment team includes not only pediatric neurosurgeons, but also endovascular neurosurgeons, interventional radiologists, radiation oncologists, neurologists, and pediatricians. Our patients receive all the advantages of a multidisciplinary team of highly trained specialists using state-of-the-art equipment.
The most common vascular conditions that we see in children are vascular malformations such as arteriovenous malformation (AVM), cavernous malformation or vein of Galen malformation; moyamoya; hereditary conditions such as Von Hippel-Lindau (VHL); and aneurysm.
Most vascular conditions can produce symptoms in three ways:
They may cause ischemia, leading to weakness, dizziness, headaches, seizures, or sensory impairment. When blockage of blood flow happens suddenly and dramatically, it is called ischemic stroke. Symptoms of ischemic stroke include sudden, severe headache, sudden confusion or loss of consciousness, sudden weakness, especially on one side of the face or body, or sudden trouble seeing from one or both eyes.
Vascular conditions may give rise to hemorrhagic stroke. Symptoms overlap with those of ischemic stroke: Patients may experience sudden onset of severe headache, confusion, weakness or vision trouble, for example. Symptoms of hemorrhagic stroke are especially likely to include nausea, vomiting and loss of consciousness.
- Vascular brain conditions can press on nearby areas of the brain. Symptoms of such pressure vary depending on which brain areas are affected. For example, conditions that block the flow of fluid in the brain cause hydrocephalus.
Occasionally, certain vascular conditions may cause other symptoms that develop slowly over time, such as seizures or a decline in cognitive abilities or performance in school.
Symptoms of vascular conditions in the brain may come on gradually or suddenly. Some sets of symptoms are more clear-cut than others. For example, seizure, vomiting, and loss of consciousness indicate a clear medical emergency. But the symptoms of a slower course of ischemia or hydrocephalus may present more slowly and may take some time to diagnose.
Tests and their timing depend on each individual’s situation.
Often the first step is a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These are painless, non-invasive tests that use X-rays or radio waves to form images of the body’s structures. They are often used to look for ischemic stroke, hemorrhagic stroke, or any lesion that may be compressing nearby brain tissue. Patients must lie very still for these scans, and young patients may need sedation to help them lie still enough.
If a vascular lesion is found, a study called an angiogram (or arteriogram) may be performed to examine the blood vessels in the brain. In this scan, a substance that shows up on X-ray is injected into the bloodstream. Then a detailed diagram of blood flow in the brain can be produced. Sedation may also be necessary during an angiogram.
Almost all vascular pediatric conditions are idiopathic.
Some are hereditary—they run in families. Some cases of VHL, moyamoya, and certain aneurysms, for example, may be hereditary.
The team approach to treatment at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital means that an array of specialists is on hand to participate in each child’s treatment.
Interventional radiologists and endovascular neurosurgeons may perform the angiogram—and may even treat some conditions during that procedure. These specialists can thread catheters through blood vessels, using them to inject substances to stop the bleeding of a hemorrhage. In some cases, this treatment, called embolization, is performed as a permanent cure. In other cases, it is performed to reduce the blood flow through the vascular malformation so that the surgery can be shorter and safer.
Neurosurgeons who specialize in stereotactic radiosurgery also treat some conditions with Gamma Knife or similar systems. These treatments require no incisions, but they may require a period of up to two to four years to reach their maximum effect. These treatments can be especially helpful for lesions that cannot be safely accessed, or fully treated, with traditional surgery or embolization.