Pediatric diagnostic cerebral angiography: practice recommendations from the SNIS Pediatric Committee

Chaudhary, Neeraj; Elijovich, Lucas; Martinez, Mesha; Fifi, Johanna T; Ortega‐Gutiérrez, Santiago; Shaibani, Ali; Pandey, Aditya S.; Suzuki, Shinichi; Field, R. Ryan; Gemmete, Joseph J.; Cooke, Daniel L; Narayanan, Sandra; Hetts, Steven W.; Orbach, Darren B.; Pearl, Monica S.

doi:10.1136/neurintsurg-2021-017389

Cited by 18 publications

(12 citation statements)

References 35 publications

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“…Once it has been confirmed that no further angiography is required, the femoral access sheath can be removed while the patient is on the biplane table to decrease postoperative straight-leg time in the pediatric intensive care unit (ICU). Femoral arterial closure is achieved with nonocclusive manual compression and postprocedural lie-flat time of 4 h [18].…”

Section: Hybrid Neuroangiography Surgical Suite With Biplanar Rotatio...mentioning

confidence: 99%

The Hybrid Operative Suite with Intraoperative Biplane Rotational Angiography in Pediatric Cerebrovascular Neurosurgery: Utility and Lessons Learned

et al. 2022

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Introduction: The benefits of performing open and endovascular procedures in a hybrid neuroangiography surgical suite include confirmation of treatment results and reduction in number of procedures, leading to improved efficiency of care. Combined procedural suites are infrequently used in pediatric facilities due to technical and logistical limitations. We report the safety, utility and lessons learned from a single-institution experience using a hybrid suite equipped with biplane rotational digital subtraction angiography and pan-surgical capabilities. Methods: We conducted a retrospective review of consecutive cases performed at our institution that utilized the hybrid neuroangiography surgical suite from February 2020 - August 2021. Demographics, surgical metrics, and imaging results were collected from the electronic medical record. Outcomes, interventions, and nuances for optimizing pre-operative/intra-operative setup and post-operative care were presented. Results: Eighteen procedures were performed in 17 patients (mean age 13.4 years, range 6-19). Cases included 14 arteriovenous malformations (AVM; 85.7% ruptured), one dural arteriovenous fistula, one mycotic aneurysm, and one hemangioblastoma. The average operative time was 416 minutes (range 321-745). There were no intra-operative or post-operative complications. All patients were alive at follow-up (range 0.1-14.7 months). Five patients had anticipated post-operative deficits arising from their hemorrhage, and 12 returned to baseline neurological status. Four illustrative cases demonstrating specific, unique applications of the hybrid angiography suite are presented. Discussion/Conclusion: The hybrid neuroangiography surgical suite is a safe option for pediatric cerebrovascular pathologies requiring combined surgical and endovascular intervention. Hybrid cases can be completed within the same anesthesia session and reduces the need for return to the operating room for resection or surveillance angiography. High-quality intra-operative angiography enables diagnostic confirmation under a single procedure, mitigating risk of morbidity and accelerating recovery. Effective multidisciplinary planning enables pre-operative angiograms to be completed to inform the operative plan immediately prior to definitive resection.

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Section: Hybrid Neuroangiography Surgical Suite With Biplanar Rotatio...mentioning

confidence: 99%

The Hybrid Operative Suite with Intraoperative Biplane Rotational Angiography in Pediatric Cerebrovascular Neurosurgery: Utility and Lessons Learned

et al. 2022

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“…There is a clear consensus for general anesthesia in the pediatric population, even for diagnostic imaging [48 ▪▪ ]. Knowledge of the presence of cardiovascular disease and its impact on daily life and upper/lower respiratory tract infections is essential [49 ▪ ].…”

Section: Retinoblastomamentioning

confidence: 99%

Anesthesia care in the interventional neuroradiology suite: an update

Bello

Paisansathan

Riva

et al. 2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe scope of procedures conducted by neurointerventionalists is expanding quickly, with lacking consensus over the best anesthesia modality. Although the procedures involve all age groups, the interventions may be complex and lengthy and may be provided in hospitals currently not yet familiar with the field. Here we review current literature addressing elective outpatient neurointerventional procedures and aim to provide an update on the management of intervention-specific crises, address special patient populations, and provide key learning points for everyday use in the neurointerventional radiology suite. Recent findingsVarious studies have compared the use of different anesthesia modalities and preinterventional and postinterventional care. Monitored anesthesia care is generally recommended for elderly patients, whereas children are preferably treated with general anesthesia. Additional local anesthesia is beneficial for procedures, such as percutaneous kyphoplasty and vascular access.

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“…Many pediatric institutions rely on the neurointerventional capabilities of a partner adult hospital for urgent or emergent catheter angiography 87,95 as pediatric neuroangiography training and experience are limited. 10 Regarding risks, diagnostic cerebral angiography is a safe procedure with expected and reported low complication rates, 10 including vessel injury, vasospasm, dissection, stroke, contrast allergy, and nephropathy. Two large series reported complication rates of 0–6.7% in 241 and 697 consecutive angiograms; 8,96 however, this includes both diagnostic and interventional procedures.…”

Section: Limitationsmentioning

confidence: 99%

“…DSA may be performed in neonates, most commonly in the setting of neurointervention for a vein of Galen malformation or other high-flow arteriovenous fistula. 10 DSA has also been reported in infants in the setting of endovascular thrombectomy, with critical factors affecting technical feasibility being the size of the femoral artery as well as the cervicocerebral vessels as they relate to mechanical thrombectomy devices and catheters. 97 DSA alone incurs more costs than the non-invasive imaging modalities of CTA or MRA.…”

Section: Limitationsmentioning

confidence: 99%

“…1 In recent years, advances have been made in the management of hemorrhagic stroke in children, including in the use of non-invasive imaging techniques to aid in diagnosing etiology. Although minimally invasive, cerebral digital subtraction angiography (DSA) has been shown to be safe in children [8][9][10] and is a valuable, and perhaps underutilized, technique for the diagnosis and management of pediatric cerebrovascular disorders in the critical care setting. Through a case-based approach, we explore the utility of DSA in critically ill children with acute ICH.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children

Harrar

Sun

Goss³

et al. 2022

J Child Neurol

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Cerebrovascular disorders are an important cause of morbidity and mortality in children. Although minimally invasive, cerebral digital subtraction angiography (DSA) has been shown to be safe in children and is a valuable, and perhaps underutilized, technique for the diagnosis and management of pediatric cerebrovascular disorders in the critical care setting. Through a case-based approach, we explore the utility of DSA in critically ill children with acute intracranial hemorrhage (ICH). We discuss the use of DSA in the acute management of aneurysm and arteriovenous malformation rupture as well as cerebral vasospasm. Those caring for critically ill children with acute ICH should consider cerebral DSA as part of a comprehensive approach to the diagnosis and management of these conditions.

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Pediatric diagnostic cerebral angiography: practice recommendations from the SNIS Pediatric Committee

Cited by 18 publications

References 35 publications

The Hybrid Operative Suite with Intraoperative Biplane Rotational Angiography in Pediatric Cerebrovascular Neurosurgery: Utility and Lessons Learned

The Hybrid Operative Suite with Intraoperative Biplane Rotational Angiography in Pediatric Cerebrovascular Neurosurgery: Utility and Lessons Learned

Anesthesia care in the interventional neuroradiology suite: an update

Cerebral Digital Subtraction Angiography in Acute Intracranial Hemorrhage: Considerations in Critically Ill Children

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