Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2024
ReviewCatheter-directed Cerebral and Spinal Angiography in Children.
Catheter-directed angiography (CDA) is the gold standard neuroimaging study employed in the workup of most neurovascular conditions in both adults and children. When neuroangiography was first introduced in 1927 by Egas Moniz, it was performed by direct percutaneous injection of a contrast bolus into the cervical carotid arteries without catheters. This method was associated with a high risk of serious complications. Though neuroangiography was performed in the pediatric population as early as in the 1940s, it was not until the 1950s that development of Seldinger technique and angiographic catheters enabled CDA to be performed as it is today.
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Vein of Galen malformations are the most common congenital neurovascular malformation and are a type of choroidal arteriovenous fistula involving the midline primitive choroidal venous circulation. The arteriovenous shunt zone of a VOGM may directly involve the embryonic precursor of the vein of Galen and/or its tributaries within the 3rd ventricle tela choroidea. Dural sinus malformations are characterized by dilated intracranial dural venous sinuses, some of which acquire multifocal arteriovenous shunts within the dural walls of these overgrown venous sinuses. Pial arteriovenous fistulae are high-flow shunts representing direct arterial to venous communication of pial blood vessels, with no definable nidus.
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Neuroimaging Clin. N. Am. · Nov 2024
ReviewSteno-occlusive Intracranial Large Vessel Arteriopathies in Childhood: A Pattern Oriented Approach to Neuroimaging Diagnosis.
Intracranial steno-occlusive large vessel arteriopathies refer to abnormalities of the arterial wall that typically express luminal stenosis. Notably, some entities that can find themselves within this category may also express luminal dilation, and/or aneurysm formation as an alternative phenotype. Intracranial steno-occlusive large vessel arteriopathies are a leading cause of arterial ischemic stroke (AIS) in children, often progress, and can predispose to recurrent brain infarction. Intracranial arterial dissections account for a subset of cases expressing the focal cerebral arteriopathy (FCA) phenotype because the affected arterial segment, clinical presentation, and AIS patterns are very similar to the inflammatory subtype of FCA.
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Neuroimaging Clin. N. Am. · Nov 2024
ReviewPediatric Spinal Vascular Abnormalities: Overview, Diagnosis, and Management.
Hemangioblastomas are true benign vascular neoplasms arising from pluripotent mesenchymal stem cells that give rise to vascular endothelial cells and are most commonly found in the cerebellum, spinal cord, brainstem, and retina. These tumors may be isolated sporadic lesions or may be associated with hereditary genetic factors in the case of von Hippel-Lindau (VHL) syndrome. Spinal cord haemangioblastomas constitute 1.1% to 2.4% of all central nervous system tumors105, with the majority being single tumors that present in the fourth decade of life 106. ⋯ The prevalence of spinal cord hemangioblastomas in children is increased among those with VHL syndrome. The thoracic cord is the most common site for spinal cord hemangioblastomas, followed by the cervical cord. Although these tumors are benign, they cause disabling symptoms due to spinal cord compression, syringomyelia, or hemorrhage from the tumor itself or from aneurysms that form on tumor-feeding arteries or intra-tumoral vessels.
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Intracranial arterial aneurysms in children are rare. They differ from adult aneurysms in their etiology, natural history, and management approach. ⋯ Endovascular treatment has become the primary interventional modality in children with intracranial aneurysms. The authors discuss the management approach to pediatric intracranial aneurysms.