Joseph Gemmete, M.D., can treat a variety of conditions using the latest interventional neuroradiology techniques.

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Treating pediatric neurovascular malformations with advanced interventional neuroradiology

issue 22 | Fall 2014

The advanced interventional neuroradiology services provided by a team of experienced pediatric neurointerventionalists and subspecialty neurosurgeons at University of Michigan C.S. Mott Children's Hospital are an integral part of the only comprehensive program in the state for the treatment of pediatric neurovascular malformations. One example of pediatric neurovascular anomalies that can be treated at U-M are Vein of Galen malformations.

Vein of Galen malformations can create abnormal dilation of vessels, shunting blood flow from its normal path, which can lead to heart failure, hydrocephalus and subarachnoid hemorrhages. If left untreated, malformations of the Vein of Galen have a high mortality rate. Open surgical repair is possible, but carries high rates of mortality and morbidity. However, endovascular procedures are increasingly being used to successfully treat these malformations.

"Vein of Galen malformations can be detected in utero. However, when a child presents with high cardiac output or hydrocephaly with no clear cause, it's possible that a malformation in the Vein of Galen is present," says Joseph Gemmete, M.D., a board certified interventional radiologist at C.S. Mott Children's Hospital. "To treat this, we insert a small catheter into the abnormal connections, either from the artery or the vein, and block off the abnormal connections with glue or coils. Then we monitor the child to determine if further treatment is required."

Although Vein of Galen malformations are rare, this condition is just one example of the type of complex pediatric neurovascular anomalies that can be treated at C.S. Mott Children's Hospital. "We can also handle advanced procedures such as embolization for choroid plexus papilloma, retinoblastomas and other skull-based tumors, as well as cerebral diagnostics," says Gemmete.

The specialists at C.S. Mott Children's Hospital can also treat other vascular problems such as lymphatic malformations, venous malformations, spinal hemangiomas, and arteriovenous malformations of the head and neck. These can usually be treated directly through the catheter, or under image guidance with ultrasound or fluoroscopy. Injections such as alcohol or doxycycline may also be utilized.

"Our team includes all the pediatric specialists — including neurosurgeons, neurologists, intensivists, cardiologists, anesthesiologists and the ICU — that are required to deliver this specialized care," explains Gemmete. "Our volume is high, so we have the expertise here that only a few centers across the country have."

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