We treat vascular abnormalities with a variety of surgeries. The choice of treatment depends on how ill your child is when diagnosed, medical history and age, and findings from studies and tests.
Vascular Diseases Treatment Options
Your child may have a procedure called embolization. In some cases, embolization fixes the problem. In others, it makes it easier for neurosurgeons to operate.
Experts called interventional radiologists do embolizations. First, they do a type of X-ray called an angiogram that lets them see your child's blood vessels. Then they put very small coils or particles into the abnormal spots in your child's blood vessels. This blocks the blood supply and causes the blood vessels to clot.
Once the blood vessel has been blocked, neurosurgeons may do an operation to remove the abnormal spot.
We also sometimes use the Gamma knife process to treat abnormal spots in blood vessels. Despite its name, the Gamma knife is not a cutting tool. It is a high-intensity radiation treatment aimed right at the problem spots.
Surgery for Vascular Diseases
Vascular diseases can be life threatening. Your child may arrive at Seattle Children's very ill from bleeding due to a problem in the blood vessels. In these cases, we may operate right away to drain the blood. Your child's neurosurgeon will talk with you about the operation.
Treatment for Specific Vascular Diseases
Aneurysms, arteriovenous malformations and cavernous malformations
Aneurysms, arteriovenous malformations and cavernous malformations are different conditions involving abnormalities in the blood vessels. But they all can cause bleeding in the brain, and their treatment may be similar.
In treating these conditions, our concern is always whether the abnormal spot in the blood vessel will bleed and cause damage. A thorough examination and testing helps our neurosurgeons decide what treatment is best:
- Gamma knife
- Craniotomy and removal (resection) of the problem spot.
Your child's neurosurgeon bases treatment recommendations on the location, size and specific details of your child's problem.
An aneurysm (pronounced ANN-yer-iz-m) is a bubble-like wide spot in an artery. It usually develops due to a weakness in the wall of an artery and is present at birth (congenital). Doctors usually find an aneurysm when it breaks open and bleeds.
Generally, aneurysms do not bleed until a person reaches middle age. But sometimes they can bleed in children. About 80 percent of the children whose aneurysms bleed are teenagers.
Signs of an aneurysm vary greatly. If an aneurysm breaks open and bleeds, it causes symptoms such as:
- Severe headaches
- Change in mental status
- Cranial nerve problems
- Sensitivity to light (photophobia)
An arteriovenous (pronounced are-TEAR-io-venus) malformation (AVM) is a tangle of small, abnormal blood vessels that bleed easily. An AVM can cause many problems.
About 90% of AVMs are in the upper portions of the brain. About 10% show up in the spinal cord. Doctors usually find an AVM when it bleeds. The AVM can bleed without warning and for no obvious reason.
Though AVMs bleed most often in adults 20 to 40 years old, they can bleed in children. A child's risk of bleeding in the area of an AVM is about 3% each year. AVMs can bleed over and over again.
A cavernous malformation is a collection of well-defined blood vessels. The condition is also called cavernous hemangioma, cavernous angioma and cavernoma. Doctors can see these blood vessels on an MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan. Some malformations have a genetic component.
Cavernous malformations usually occur in the upper portion of the brain. A child can have more than one. Doctors often find them after a child bleeds. Some children with cavernous malformations have seizures.
Moyamoya (pronounced MOY-a-MOY-a) is a problem with blood flow to the brain. It happens when the major blood vessels in the brain (internal carotid arteries) become narrowed (stenosis). This narrowing decreases the space inside the vessels, making it harder for oxygen-rich blood to get through.
In response, small blood vessels form to create a new path for blood to flow. On an angiogram, the new vessels look like a puff of smoke. In Japan, where the condition was first documented, “moyamoya” means “hazy puff of smoke.”
Some people have moyamoya from very early childhood. Others develop it as they get older. Moyamoya gets worse over time. Decreased blood flow to the affected area may cause a transient ischemic attack, stroke and seizures.
Children with other medical conditions or certain procedures may be at greater risk for moyamoya. This includes:
- A history of radiation therapy for a brain tumor
- Neurofibromatoses (NF) type 1
- Down syndrome
- Sickle cell disease
- Noonan syndrome
- Other syndromes caused by problems with chromosomes
Surgery called pial synangiosis creates a way for more blood to get to the brain. It involves freeing part of the superficial temporal artery (STA) from the child’s scalp. Neurosurgeons open the child’s skull and attach the artery onto the surface of the brain. Then new vessels grow from the artery down into the brain and increase blood flow to the area.
Read more about moyamoya, its symptoms and diagnosis, and treatment at Seattle Children’s.
Vein of Galen malformation
The vein of Galen is located deep in the brain. A vein of Galen malformation is a ballooning (aneurysm) in this vein. The problem involves other blood vessels that drain into the vein of Galen.
This is a rare malformation. We see two or three babies a year with vein of Galen malformation.
A vein of Galen malformation can become large, causing problems that include hydrocephalus, heart failure and poor blood supply to the brain tissue.
Between 30% and 40% of babies with vein of Galen malformation die. About 60% to 80% of babies who develop heart failure die.
Treatment for vein of Galen malformation depends on your child's needs. Doctors often treat babies with vein of Galen malformations by first doing a procedure (embolization) to slow blood flow to the problem spot. Babies often need more than one embolization.