Vascular  Pathologies

Vascular pediatric neurosurgery pathologies encompass a range of conditions involving blood vessels in the brain and spinal cord of children. These conditions can vary from congenital abnormalities to acquired disorders. As a pediatric neurosurgeon in New York at Children's Hospital at Montefiore (CHAM), below is a list of vascular pediatric neurosurgery pathologies:

1. Aneurysm: Abnormal and localized bulging or ballooning of a blood vessel's wall that compromises the integrity of the vessels and makes it prone to rupture and hemorrhage into healthy brain tissue.  Given the cumulative risk of annual rupture in children associated with aneurysm, definitive treatment such as surgical clipping is a favorable treatment modality. Endovascular interventions such as: coiling, stent assisted coiling, pipeline/flow diverters, WEB, and other emerging technologies are also feasible. 

2. Arteriovenous Malformations (AVMs): Abnormal tangles of blood vessels connecting arteries and veins, which can cause bleeding and seizures. Treatment may involve surgical resection, endovascular embolization, radiation/gamma knife, or a combination of approaches.

3. Cavernous Malformations (Cavernomas): Clusters of dilated, thin-walled veins that can lead to foal bleeding, neurological deficits, and seizures. Surgical removal may be considered if persistently symptomatic.

4. Vein of Galen Malformation: An abnormal connection between arteries and the deep cerebral veins, leading to high-flow arteriovenous shunting, heart failure, and seizures.This can be diagnosed in a fetus, newborns, or children. Embolization is the mainstay of treatment.

5. Dural Arteriovenous Fistulas (DAVFs): Abnormal connections between arteries and veins within the dura mater, the outermost layer of the brain's protective coverings. Surgical disconnection or endovascular treatment are mainstays of treatment.

6. Perimedullary Arteriovenous Fistulas: Abnormal connections between spinal arteries and veins, which can lead to spinal cord injury. Surgical removal or endovascular treatment may be considered.

7. Spinal Dural Arteriovenous Fistulas (SDAVFs): Abnormal connections between spinal arteries and veins within the dura mater of the spinal cord. Treatment may involve embolization or surgical intervention.

8. Capillary Telangiectasias: Benign, small, dilated blood vessels that can be present since birth and usually do not require treatment unless they cause symptoms.

9. Pediatric Stroke: Blood flow disruption in the brain, which can lead to brain damage. This can occur in varying stage of development, including intrauterine, perinatal, childhood or adolescence. Treatment entirely depends on the etiology of stroke; however, the focus remains on saving the yet uninjured brain tissue and prevention of future strokes.

10. Moyamoya Disease: Progressive narrowing and occlusion of the internal carotid arteries, large vessels at the base of the brain, leading to reduced blood flow and potentially strokes. Revascularization surgeries may be performed to improve blood supply.

11. Carotid-Cavernous Fistulas: High flow connections between the carotid artery and the cavernous sinus, which can occur due to iatrogenic causes, infection, or trauma. This can often present with eye-related symptoms of bulging eye, decrease in vision, redness and irritation of the eye. Treatment often involve endovascular embolization.

12. Vascular Tumors: Certain tumors, such as hemangioblastomas or infantile hemangiomas, contain an extensive and intricate blood supply that may require embolization prior to surgical resection. Vasculitis: Inflammation of blood vessels that can affect the brain and spinal cord. Treatment aims to manage the underlying condition and may involve immunosuppressive therapy.

13. Arterial Dissections: Tears in the inner lining of an artery, which can lead to reduced blood flow, clot formation within the vessel that can lead to strokes . Treatment may involve anticoagulation, endovascular procedures.

14. Hereditary Hemorrhagic Telangiectasia (HHT): A genetic disorder causing abnormal blood vessel development, leading to multiple telangiectasias and AVMs. Treatment focuses on symptom management.

15. Klippel-Trenaunay Syndrome: A rare condition characterized by abnormal blood vessels, soft tissue overgrowth, and bone anomalies. Treatment may involve symptomatic management.

16. Sturge-Weber Syndrome: A rare disorder causing abnormal blood vessels in the face, eye, and brain, often leading to seizures and neurological symptoms. Treatment is aimed at symptom control.

17. Cerebral Vasospasm: Narrowing of cerebral arteries following a subarachnoid hemorrhage, leading to reduced blood flow. Treatment may involve medical management and endovascular interventions.