Vascular Diseases of the Brain and Spinal Cord

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, most often teenagers.

If an aneurysm breaks open and bleeds, it causes symptoms such as:

• Severe headaches
• Vomiting
• Change in mental state
• Coma
• Problems affecting the nerves in the skull (cranial nerves)
• Seizures
• Sensitivity to light (photophobia)

Doctors usually find an AVM because it bleeds. The AVM can bleed without warning and for no obvious reason. They can bleed over and over again. Though AVMs bleed most often in adults 20 to 40 years old, they also can bleed in children.

Read more about symptoms of arteriovenous malformations.

Symptoms of cerebral cavernous malformations vary from child to child. Symptoms may come and go as it bleeds and then the body absorbs the blood.

Read more about symptoms of this condition and how we care for children with cerebral cavernous malformations at Seattle Children’s.

Some people have moyamoya from very early childhood. Others develop it as they get older. Decreased blood flow to the affected area may cause:

• A transient ischemic attack
• Stroke
• Seizures

Read more about moyamoya at Seattle Children’s.

Symptoms of stroke tend to be different in newborns than in older children. Strokes that happen while a fetus is developing during pregnancy or within 1 month after birth are called perinatal.

• Seizures are a common symptom of perinatal stroke.
• Most newborns with stroke have general symptoms that can also be caused by other conditions.
• A stroke after the first month of life causes symptoms that come on suddenly, like severe headache or weakness on 1 side.

Read more about stroke symptoms.

If a vein of Galen malformation becomes large, it may cause problems that include:

• Buildup of fluid in the brain (hydrocephalus)
• Heart failure, because an abnormally high flow of blood strains the heart
• Poor blood supply to the brain

Craniotomy is a procedure to open the skull, so a neurosurgeon can operate on your child’s brain. Sometimes doctors open the skull to reduce pressure on the brain caused by bleeding or swelling.

The neurosurgeon:

• Cuts and temporarily removes a piece of bone from the skull
• Opens the tough membrane that protects the brain (dura mater)
• Removes or treats the diseased area of the brain, such as a weak part of a blood vessel
• Closes the dura mater
• Closes the skull, using your child’s bone or hardware such as micro plates, screws and wires

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.

Surgeons and 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.
• Next, doctors put either medical-grade Super Glue or very small coils or particles into the abnormal blood vessels.
• When the glue hardens, the surgeon can clearly identify the boundaries of the malformation and cleanly remove it.
• Sometimes we use coils or particles to block the blood supply and cause the blood vessels to clot. This makes it easier to remove the tangled clumps of extra veins.

We sometimes use the gamma knife process to treat tangles of abnormal blood vessels. Despite its name, the gamma knife is not a cutting tool. It is a high-intensity radiation therapy aimed right at the problem spots. The precise targeting means it can treat very small areas. This helps avoid harm to normal tissue. This noninvasive surgery takes place at Harborview Medical Center.

This precise, minimally invasive option uses light to heat and destroy unwanted cells. Seattle Children’s is the only pediatric hospital in the Pacific Northwest — and among a handful of centers in the country — to offer laser ablation surgery. It may be a treatment option if your child’s condition causes seizures. Read more about laser ablation.

There is no medicine to get rid of vascular malformations. But medicines may help ease symptoms, such as headaches and seizures.

We are very experienced in diagnosing and treating children, teens and young adults with all types of seizures.

Revascularization surgery restores blood flow to part of the body that was not getting enough oxygen-rich, nutrient-rich blood. Children with moyamoya often need this type of surgery. Neurosurgeons may redirect a blood vessel toward tissue that needs more oxygen. Another option is to move a piece of a blood vessel from 1 part of the body to another to create a channel for blood flow.

Treatment for aneurysms, arteriovenous malformations and cavernous malformations may be similar because they all can cause bleeding in the brain. In treating these conditions, our concern is always whether the abnormal spot in the blood vessel will bleed and cause damage. A full examination and testing help our neurosurgeons decide what treatment is best: 

• Embolization
• 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. Read more about how Seattle Children’s treats children with:

• Arteriovenous malformations (AVMs)
• Cavernous malformations

Doctors treat moyamoya with surgery to bring new blood supply to the brain. Children come here from across the country for a type of revascularization surgery called pial synangiosis (PEE-ul sin-an-JOE-sis) to improve blood flow to their brain. 

Your child’s team at Seattle Children’s will also recommend steps to help reduce risk of stroke.

Read more about moyamoya, its symptoms, diagnosis and treatment at Seattle Children’s.

Some children’s care starts in our Emergency Department during or right after having a stroke. Other children come to us after care at another hospital. Our Pediatric Vascular Neurology team will care for your child.

Your child’s treatment will depend on the type of stroke they had, how it affected your child and the cause. Treatment options include medicines, surgery, rehabilitation and treatment for any underlying causes.

Read about our care for babies, children and young adults with stroke.

Treatment for vein of Galen malformation depends on your child’s needs. Often the first treatment is embolization. This slows blood flow to the problem spot. Babies often need more than 1 embolization.

A vein of Galen malformation can become large, causing life-threatening problems. These include:

• A buildup of cerebrospinal fluid (CSF) in the brain (hydrocephalus). This is dangerous if not treated, because it can increase pressure in the brain.
• Heart failure, because an abnormally high flow of blood strains the heart.
• Poor blood supply to the brain.

Members of your child’s team work together and with you to develop the best treatment plan to take care of all of your child’s health needs.

• Your child’s team will check for signs of hydrocephalus and increased pressure in the brain. Your child may need a tube (shunt) inserted to drain away extra fluid. The fluid drains into another part of the body, where it can be absorbed.
• Our Heart Center has more than 40 pediatric cardiologists with experience diagnosing and treating kids in a child-focused, healing environment.
• If reduced blood flow harms your child’s brain, we provide rehabilitation, so your child has the best possible recovery.

As your child gets older, we prepare them to take on a greater role in their own care. When your child is ready, we connect them with experts who can meet their adult healthcare needs.

We work closely with neurologists and neurosurgeons at Harborview Medical Center who treat vascular diseases of the brain and spinal cord.

Cerebrovascular diseases can be life threatening. Our skilled experts are here when you need them.

• A pediatric stroke expert is available 24 hours a day, 7 days a week.
• Our Emergency Department provides immediate care all hours of the day and night for babies, children and teens who need it.
• Our Neuro NICU is the only neonatal neurocritical care program in Washington, Wyoming, Alaska, Montana and Idaho.
• We have a Level IV Neonatal ICU as well as a Pediatric Intensive Care Unit (ICU).
• Our Neurocritical Care team provides treatment to protect your child’s brain, prevent new issues and help your child heal.
• We provide coordinated care in special clinics focused on the complex needs of children with conditions that increase their risk of stroke or brain injury.

• Our Pediatric Vascular Neurology Program providers are experts in pediatrics and the ways cerebrovascular conditions are different in children than in adults.
• Our team bases your child’s treatment plans on years of experience and the newest research on what is best for children and teens.
• We address your child’s changing needs, whether they are a young child going back to school after brain surgery or a teen taking on more responsibility for their health.
• As your child gets older, we prepare them to take on a greater role in their own care. When the time is right, we help them transition to a provider who can meet their adult healthcare needs.

• During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.
• We understand that stroke and other neurovascular conditions can have profound effects on your child and family. Our doctors, nurses, child life specialists and social workers are here to help. Our compassionate experts connect you with support and resources to help your child and family cope.
• We take care of your child over the long term. If bleeding or reduced blood flow harms your child’s brain, we provide rehabilitation so they have the best possible recovery.
• At Seattle Children’s, we work with children and families from around the Northwest and beyond. We can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.