Pediatric Neurosurgery

PEDIATRIC VASCULAR ANOMALIES

VASCULAR ANOMALIES

Arterio-Venous Malformation (AVM)

  • Angiogram necessary
  • Treatment is:
    • Surgery
    • Gamma Knife
    • Embolization
  • 1%/yr risk of hemorrhage
  • 50% mortality with hemorrhage

Spetzler Martin AVM Operative Risk Grading System

Risk Factors:

    Size:
  • <3cm           1
  • 3 to 6 cm     2
  • over 6 cm    3

Position:

  • silent            0
  • eloquent      1

Veins:

  • superficial       0
  • deep               1

VASCULAR ANOMALIES

Arterio-Venous Fistula

  • Angiogram necessary
  • Treatment is
    • Surgery
    • Embolization
  • Often caused by trauma

Cavernous Hemangioma

  • MRI necessary
  • Usually angiographically absent
  • Low flow
  • Low risk of hemorrhage
    • Treatment is dependent on symptoms(hemorrhage, head-aches, seizures)

Venous Angioma

  • MRI necessary
  • Low flow
  • No risk of hemorrhage
    • Treatment will cause a stroke (no treatment is given)

Carotid stenosis(Moya Moya)

  • More common in the sickle cell patient population
  • High risk of stroke (80% at 2 years)
  • Medical treatment with transfusion reduces stroke rate in sickle cell patient population
  • Surgical management
    • EC-IC bypass
    • Pial synangiosis