Pediatric interventional Neuroradiology
Olivier NAGGARA | Thomas BLAUWBLOMME
Seance of wednesday 12 june 2024 (L'Académie de chirurgie reçoit la Société de Française de Neuro-Radiologie)
DOI number : 10.26299//emem.2024.20.04
Abstract
Paediatric interventional neuroradiology (INR) in children, infants, and neonates involves all endovascular, minimally invasive therapeutic procedures used to treat cerebral vascular malformations.
While there are common elements in paediatric care that overlap with adult INR, with the primary similarity being the severe prognosis in the absence of treatment for most conditions, many specific nosological, treatment strategy, and approach differences are highlighted in developing individuals.
In adults, INR is mainly concerned with acquired conditions (such as intracranial aneurysms, ischaemic or haemorrhagic strokes, arterial and venous stenoses), whereas in children, the most frequently observed conditions are congenital or develop early in life. These predominantly include high-flow cerebral arteriovenous shunts (such as pial malformations, vein of Galen malformations, dural sinus malformations, and pial fistulas).
The gradual understanding of these malformations and the pathological processes they cause according to the child's age, alongside technological advancements and the miniaturisation of equipment, has established endovascular treatment as the primary management strategy for these conditions. The key challenge is to determine the optimal therapeutic window, balancing the technical difficulties of very early intervention, the tolerance to the shunt, and the impact on the child's development. This challenge, identifying the ideal age for treating these malformations, is further emphasised with the emerging possibility of antenatal diagnosis and treatment of some conditions. Dissecting these conditions, particularly their genetic characteristics, offers promising prospects for identifying drug treatments that complement endovascular treatment.
While there are common elements in paediatric care that overlap with adult INR, with the primary similarity being the severe prognosis in the absence of treatment for most conditions, many specific nosological, treatment strategy, and approach differences are highlighted in developing individuals.
In adults, INR is mainly concerned with acquired conditions (such as intracranial aneurysms, ischaemic or haemorrhagic strokes, arterial and venous stenoses), whereas in children, the most frequently observed conditions are congenital or develop early in life. These predominantly include high-flow cerebral arteriovenous shunts (such as pial malformations, vein of Galen malformations, dural sinus malformations, and pial fistulas).
The gradual understanding of these malformations and the pathological processes they cause according to the child's age, alongside technological advancements and the miniaturisation of equipment, has established endovascular treatment as the primary management strategy for these conditions. The key challenge is to determine the optimal therapeutic window, balancing the technical difficulties of very early intervention, the tolerance to the shunt, and the impact on the child's development. This challenge, identifying the ideal age for treating these malformations, is further emphasised with the emerging possibility of antenatal diagnosis and treatment of some conditions. Dissecting these conditions, particularly their genetic characteristics, offers promising prospects for identifying drug treatments that complement endovascular treatment.