Evolution of Endovascular Treatment in Pediatric Population

  • Silky Chotai
  • Abhishek Agrawal


Endovascular treatment has been increasingly used for treatment of various cerebrovascular pathologies in pediatric population. Endovascular treatment is considered the primary treatment modality for dural AVFs or vein of Galen malformations, while it is often used as adjuvant therapy for AVMs and tumors. A number of studies have reported the safety of the endovascular procedures in children and have reported the complication rates similar to that in adults. The management of vascular diseases in children is challenging. The pediatric patients are not only small adults, but also differ substantially with regards to factors such as growth and development of child and different morphology and natural history of the pathology. Furthermore, these patients have longer life span demanding a more durable treatment options, close surveillance and follow-up compared to adults. Standardized treatment recommendations on endovascular management in pediatric population are lacking. The focus of this chapter is to describe history and evolution of endovascular neurosurgery in pediatric population.


Endovascular Neurointervention Pediatric History Evolution Neurosurgery 


  1. 1.
    terBrugge KG. Neurointerventional procedures in the pediatric age group. Childs Nerv Syst. 1999;15(11–12):751–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Zaidi HA, Kalani MY, Spetzler RF, McDougall CG, Albuquerque FC. Multimodal treatment strategies for complex pediatric cerebral arteriovenous fistulas: contemporary case series at Barrow Neurological Institute. J Neurosurg Pediatr. 2015;15(6):615–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Vasan R, Patel J, Sweeney JM, et al. Pediatric intracranial aneurysms: current national trends in patient management and treatment. Childs Nerv Syst. 2013;29(3):451–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Sanai N, Quinones-Hinojosa A, Gupta NM, et al. Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg Pediatr. 2006;104(2):82–9.CrossRefGoogle Scholar
  5. 5.
    Egaz M. L’encephalographiearterielle, sonimportancedanslalocalization des temeurs cerebrales. Rev Neurol. 1927;2:72–90.Google Scholar
  6. 6.
    Egaz M. Cerebral angiography: its application in clinical practice and physiology. Lancet. 1933;225:1144–7.Google Scholar
  7. 7.
    Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg. 1974;41(2):125–45.CrossRefPubMedGoogle Scholar
  8. 8.
    Berenstein A, Song JK, Niimi Y. Personal accounts of the evolution of endovascular neurosurgery. Neurosurgery. 2006;59(5 Suppl 3):S15–21; discussion S13-13.PubMedGoogle Scholar
  9. 9.
    Guglielmi G. History of endovascular surgery: personal accounts of the evolution. Neurosurgery. 2007;61(6):E1340; author reply E1340.CrossRefPubMedGoogle Scholar
  10. 10.
    Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg. 1991;75(1):8–14.CrossRefPubMedGoogle Scholar
  11. 11.
    Guglielmi G, Vinuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electrochemical basis, technique, and experimental results. J Neurosurg. 1991;75(1):1–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Prestigiacomo CJ. Historical perspectives: the microsurgical and endovascular treatment of aneurysms. Neurosurgery. 2006;59(5 Suppl 3):S39–47; discussion S33-13.PubMedGoogle Scholar
  13. 13.
    Yang M, Wang S, Zhao Y, Zhao J. Management of intracranial aneurysm in children: clipped and coiled. Childs Nerv Syst. 2008;24(9):1005–12.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Yu JM, Fan GP, Zhong WX. Interventional treatment of intracranial aneurysm in children. J Chin Clin Med Imaging. 2002;13:161–3.Google Scholar
  15. 15.
    He L, Ladner TR, Pruthi S, et al. Rule of 5: angiographic diameters of cervicocerebral arteries in children and compatibility with adult neurointerventional devices. J Neurointerv Surg. 2016;8(10):1067–71.Google Scholar
  16. 16.
    Kakarla UK, Beres EJ, Ponce FA, et al. Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes. Neurosurgery. 2010;67(2):237–49; discussion 250.CrossRefPubMedGoogle Scholar
  17. 17.
    Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(9342):1267–74.CrossRefPubMedGoogle Scholar
  18. 18.
    Molyneux AJ, Kerr RS, Birks J, et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009;8(5):427–33.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Fox AJ, Vinuela F, Pelz DM, et al. Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg. 1987;66(1):40–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Higashida RT, Halbach VV, Dowd C, et al. Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg. 1990;72(6):857–63.CrossRefPubMedGoogle Scholar
  21. 21.
    Kondo S, Aoki T, Nagao S, Gi H, Matsunaga M, Fujita Y. A successful treatment of giant carotid artery aneurysm by a detachable balloon technic; a child case. Neurol Surg. 1988;16(11):1299–304.Google Scholar
  22. 22.
    Picard L, Bracard S, Lehericy S, et al. Endovascular occlusion of intracranial aneurysms of the posterior circulation: comparison of balloons, free coils and detachable coils in 38 patients. Neuroradiology. 1996;38 Suppl 1:S133–41.CrossRefPubMedGoogle Scholar
  23. 23.
    Beez T, Steiger HJ, Hanggi D. Evolution of management of intracranial aneurysms in children: a systematic review of the modern literature. J Child Neurol. 2015;31(6):773–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Jian BJ, Hetts SW, Lawton MT, Gupta N. Pediatric intracranial aneurysms. Neurosurg Clin N Am. 2010;21(3):491–501.CrossRefPubMedGoogle Scholar
  25. 25.
    Hetts SW, Narvid J, Sanai N, et al. Intracranial aneurysms in childhood: 27-year single-institution experience. AJNR Am J Neuroradiol. 2009;30(7):1315–24.CrossRefPubMedGoogle Scholar
  26. 26.
    Kanaan Y, Kaneshiro D, Fraser K, Wang D, Lanzino G. Evolution of endovascular therapy for aneurysm treatment. Historical overview. Neurosurg Focus. 2005;18(2):E2.CrossRefPubMedGoogle Scholar
  27. 27.
    Krings T, Geibprasert S, terBrugge KG. Pathomechanisms and treatment of pediatric aneurysms. Childs Nerv Syst. 2010;26(10):1309–18.CrossRefPubMedGoogle Scholar
  28. 28.
    Stiefel MF, Heuer GG, Basil AK, et al. Endovascular and surgical treatment of ruptured cerebral aneurysms in pediatric patients. Neurosurgery. 2008;63(5):859–65; discussion 865–856.CrossRefPubMedGoogle Scholar
  29. 29.
    Pierot L. Flow diverter stents in the treatment of intracranial aneurysms: where are we? J Neuroradiol. 2011;38(1):40–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Brooks M. FDA clears next-generation brain aneurysm device. 2015;
  31. 31.
    Lylyk P, Miranda C, Ceratto R, et al. Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery. 2009;64(4):632–42; discussion 642–633; quiz N636.CrossRefPubMedGoogle Scholar
  32. 32.
    Navarro R, Brown BL, Beier A, Ranalli N, Aldana P, Hanel RA. Flow diversion for complex intracranial aneurysms in young children. J Neurosurg Pediatr. 2015;15(3):276–81.CrossRefPubMedGoogle Scholar
  33. 33.
  34. 34.
    Vargas SA, Diaz C, Herrera DA, Dublin AB. Intracranial aneurysms in children: the role of stenting and flow-diversion. J Neuroimaging. 2016;26(1):41–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Saraf R, Shrivastava M, Siddhartha W, Limaye U. Intracranial pediatric aneurysms: endovascular treatment and its outcome. J Neurosurg Pediatr. 2012;10(3):230–40.CrossRefPubMedGoogle Scholar
  36. 36.
    Bergstrand HOH, Tonnis W. Gefabmibbildungen und Gefabgeschwulste des Gehirns. Leipzig: Thieme; 1936.Google Scholar
  37. 37.
    Norlen G. Arteriovenous aneurysms of the brain; report of ten cases of total removal of the lesion. J Neurosurg. 1949;6(6):475–94.CrossRefPubMedGoogle Scholar
  38. 38.
    Pool JL. Treatment of arteriovenous malformations of the cerebral hemispheres. J Neurosurg. 1962;19:136–41.CrossRefPubMedGoogle Scholar
  39. 39.
    French LCS. Conventional methods of treating intracranialarteriovenous malformations. Prog Neurol Surg. 1969;3:274–319.CrossRefGoogle Scholar
  40. 40.
    Sano K. Intracranial arterio-venous malformation with special reference to its treatment. Neurol Med Chir. 1964;6:28–34.CrossRefGoogle Scholar
  41. 41.
    Seljeskog EL, Rogers HM, French LA. Arteriovenous malformation involving the inferior sagittal sinus in an infant. Case report. J Neurosurg. 1968;29(6):623–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Luessenhop AJ, Spence WT. Artificial embolization of cerebral arteries. Report of use in a case of arteriovenous malformation. J Am Med Assoc. 1960;172:1153–5.CrossRefPubMedGoogle Scholar
  43. 43.
    Rabinov JD, Yoo AJ, Ogilvy CS, Carter BS, Hirsch JA. ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas. J Neurointerv Surg. 2013;5(4):306–10.CrossRefPubMedGoogle Scholar
  44. 44.
    Benati A, Beltramello A, Colombari R, et al. Preoperative embolization of arteriovenous malformations with polylene threads: techniques with wing microcatheter and pathologic results. AJNR Am J Neuroradiol. 1989;10(3):579–86.PubMedGoogle Scholar
  45. 45.
    Lawton MT, Hamilton MG, Spetzler RF. Multimodality treatment of deep arteriovenous malformations: thalamus, basal ganglia, and brain stem. Neurosurgery. 1995;37(1):29–35; discussion 35–26.CrossRefPubMedGoogle Scholar
  46. 46.
    Gobin YP, Laurent A, Merienne L, et al. Treatment of brain arteriovenous malformations by embolization and radiosurgery. J Neurosurg. 1996;85(1):19–28.CrossRefPubMedGoogle Scholar
  47. 47.
    Lasjaunias P, Hui F, Zerah M, et al. Cerebral arteriovenous malformations in children. Management of 179 consecutive cases and review of the literature. Childs Nerv Syst. 1995;11(2):66–79; discussion 79.CrossRefPubMedGoogle Scholar
  48. 48.
    Humphreys RP, Hoffman HJ, Drake JM, Rutka JT. Choices in the 1990s for the management of pediatric cerebral arteriovenous malformations. Pediatr Neurosurg. 1996;25(6):277–85.PubMedGoogle Scholar
  49. 49.
    Kondziolka D, Humphreys RP, Hoffman HJ, Hendrick EB, Drake JM. Arteriovenous malformations of the brain in children: a forty year experience. J Can Sci Neurol. 1992;19(1):40–5.Google Scholar
  50. 50.
    Perini S, Zampieri P, Rosta L, et al. Endovascular treatment of pial AVMs: technical options, indications and limits in pediatric age patients. J Neurosurg Sci. 1997;41(4):325–30.PubMedGoogle Scholar
  51. 51.
    Madsen PJLS, Pisapia JM, Storm PB, Hurst RW, Heuer GG. An institutional series and literature review of pial arteriovenous fistulas in the pediatric population. Clinical article. J Neurosurg Pediatr. 2013;12:344–50.CrossRefPubMedGoogle Scholar
  52. 52.
    Guglielmi G. History of endovascular endosaccular occlusion of brain aneurysms: 1965–1990. Interv Neuroradiol. 2007;13(3):217–24.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Orthopedics and NeurosurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of NeurosurgeryThe Methodist Neurological InstituteHoustonUSA

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