Neurointerventions in Children: Radiation Exposure and Its Import

Orbach, Darren B.; Stamoulis, Catherine; Strauss, Keith J.; Manchester, J; Smith, Edward R.; Scott, R. Michael; Lin, Ning

doi:10.3174/ajnr.a3758

Cited by 50 publications

(27 citation statements)

References 11 publications

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“…The radiation dosage and projected stochastic effects of radiation exposure for each patient were also recorded as part of the complication analysis for some of this cohort; these results were reported separately. 22 …”

Section: Patient Selectionmentioning

confidence: 99%

Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients

Lin

Smith²,

Scott³

et al. 2015

PED

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OBJECT The safe treatment of children using catheter-based angiography and embolization poses unique challenges because of the technical factors regarding the size and fragility of access and target vessels, as well as unique pediatric cerebrovascular pathologies. The complication rates for neurointerventional procedures in children have not been established. METHODS The records of a consecutive cohort of pediatric patients who underwent neuroangiography and/or embolization between 2007 and 2013 were reviewed retrospectively to identify both intraprocedural and postprocedural complications. Demographic and clinical risk factors were analyzed with a multivariate logistic regression model. RESULTS The 697 consecutive procedures consisted of 429 diagnostic angiograms and 268 embolizations (mean age of patients 11.1 years; range 4 days to 18 years; 217 females). There were 130 intracranial, 122 extracranial, and 16 spinal embolizations. Pathologies included 28 intracranial arteriovenous malformations (AVMs), 12 spinal AVMs, 19 aneurysms, 29 vein of Galen malformations, 29 dural arteriovenous fistulas, 96 extracranial AVMs, 39 tumors, 3 strokes, and 13 others. Overall, 2 intraprocedural and 1 postprocedural complication (0.7%) occurred in the diagnostic group, all of which were nonneurological events. In the embolization group, 7 intraprocedural and 11 postprocedural complications (6.7%) were observed. Of these complications, 15 were nonneurological events (5.6%), 1 was a short-term neurological event (0.4%), and 2 were long-term neurological events (0.7%). CONCLUSIONS Neither the technical challenges posed by children’s access and target vessels nor the unique neuro-vascular pathologies seen in children need result in an elevated morbidity rate related to neuroangiography and embolization. At a dedicated high-volume center, the complication rates may be lower than those for comparable procedures performed in adults.

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Section: Patient Selectionmentioning

confidence: 99%

Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients

Lin

Smith²,

Scott³

et al. 2015

PED

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“…Ours is the largest series of the case series in the literature that attempts to quantify the effect of proper collimation on lifetime exposure of pediatric populations 6 8 17 18. The adverse effects of ionizing radiation are categorized as deterministic and stochastic.…”

Section: Discussionmentioning

confidence: 99%

Pediatric neurointervention: collimation on radiation exposure-associated lifetime excess tumor risk

Paramasivam

Berenstein

2016

J NeuroIntervent Surg

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“…Infants experience a slightly higher dose due to skull thickness, but the total is still less than 1 Gy. 22 White et al demonstrated that in children undergoing surveillance for shunt malfunction, the mean brain dose from a mean of 16.3 CT scans in the first year of life was 321 mGy, with no increase in the risk of malignancy over the 10-21 years of follow-up. 30 Consistent with this conclusion, the largest study of population-based risk of malignancy after radiation exposure by dose demonstrated no significant increase in the relative risk of malignancy after exposure to 0.01-9.99 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…1,9,16 Concern regarding the safety of radiation exposure in children has caused a shift away from studies involving the use of ionizing radiation, such as angiography and CT. 7,22 Recent estimates have placed the mean radiation dose to the skin from a single diagnostic angiogram in a child under the age of 21 at 239.4 mGy, while the dose absorbed by the brain is lower. Infants experience a slightly higher dose due to skull thickness, but the total is still less than 1 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…The appropriate follow-up modality and timing are therefore subjects of debate, particularly in light of concerns regarding radiation exposure and general anesthesia in children. 7,22,30 We present our experience with surveillance for AVM recurrence, associated risk factors, and clinical outcome, while considering the implications of these findings for follow-up protocols after treatment.…”

mentioning

confidence: 99%

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Postoperative imaging for detection of recurrent arteriovenous malformations in children

Morgenstern

Hoffman

Kocharian

et al. 2016

PED

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OBJECT The optimal method for detecting recurrent arteriovenous malformations (AVMs) in children is unknown. An inherent preference exists for MR angiography (MRA) surveillance rather than arteriography. The validity of this strategy is uncertain. METHODS A retrospective chart review was performed on pediatric patients treated for cerebral AVMs at a single institution from 1998 to 2012. Patients with complete obliteration of the AVM nidus after treatment and more than 12 months of follow-up were included in the analysis. Data collection focused on recurrence rates, associated risk factors, and surveillance methods. RESULTS A total of 45 patients with a mean age of 11.7 years (range 0.5–18 years) were treated for AVMs via surgical, endovascular, radiosurgical, or combined approaches. Total AVM obliteration on posttreatment digital subtraction angiography (DSA) was confirmed in 27 patients, of whom the 20 with more than 12 months of follow-up were included in subsequent analysis. The mean follow-up duration in this cohort was 5.75 years (median 5.53 years, range 1.11–10.64 years). Recurrence occurred in 3 of 20 patients (15%). Two recurrences were detected by surveillance DSA and 1 at the time of rehemorrhage. No recurrences were detected by MRA. Median time to recurrence was 33.6 months (range 19–71 months). Two patients (10%) underwent follow-up DSA, 5 (25%) had DSA and MRI/MRA, 9 (45%) had MRI/MRA only, 1 (5%) had CT angiography only, and 3 (15%) had no imaging within the first 3 years of follow-up. After 5 years posttreatment, 2 patients (10%) were followed with MRI/MRA only, 2 (10%) with DSA only, and 10 (50%) with continued DSA and MRI/MRA. CONCLUSIONS AVM recurrence in children occurred at a median of 33.6 months, when MRA was more commonly used for surveillance, but failed to detect any recurrences. A recurrence rate of 15% may be an underestimate given the reliance on surveillance MRA over angiography. A new surveillance strategy is proposed, taking into account exposure to diagnostic radiation and the potential for catastrophic rehemorrhage.

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Neurointerventions in Children: Radiation Exposure and Its Import

Cited by 50 publications

References 11 publications

Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients

Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients

Pediatric neurointervention: collimation on radiation exposure-associated lifetime excess tumor risk

Postoperative imaging for detection of recurrent arteriovenous malformations in children

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