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Management and Treatment of Pediatric Neurovascular Diseases in an Interdisciplinary



Abstract

The article “Management and Treatment of Pediatric Neurovascular Diseases in an Interdisciplinary Setting” states that Pediatric Neurovascular Disease (PDN) is characterized by diverse patterns such as Vein of Galen (VOG), cerebral aneurysms Arteriovenous (AVM), Ischemic stroke, Developmental Venous Anomalies (DVA) and Cerebral Cavernous Malformations (CCM) as well as other non frequent clinical units such as Moyamoya disease. Although these diseases are not usual in clinical practice, they require proper treatment and multidisciplinary coordination of neurosurgeons and frequent intervention of pediatricians and neuro-radiologists.

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Pediatric Neurovascular Diseases

Maslehaty et al. (2014) argues that VOG malformations are treated using endovascular embolization. This clinical practice is characterized by high mortality rate, as patients are subjects to high blood pressure . AVM anomalies, which are most widespread in pediatry, are characterized by hemorrhage, seizures, local mass effect and steal syndrome. AVM requires doctors to pay close attention to the clinical course due to the high probability of bleeding. Treatment of AVM requires surgical intervention. However, it is chracterized with low rates of complication .

Ischemic stroke is caused by cerebral vasculopathies, head trauma, Moyamoya disease, infections and cardiac disorders. The authors argue that there is a need to raise awareness in Ischemic stroke in clinical practice because it is often overlooked and ,thus, the treatment is delayed till its latest stages. The best method to treat Ischemic stroke is endovascular treatment, which includes recanalization of occluded vessel and patency of the affected vessel through the implantation of intra-arterial stent.

Intracranial aneurysms are not common in children though they are diagnosed with rupture,subarachnoid hemorrhage and aneurysm in the posterior fossa. Intracranial aneurysm can be treated surgically or by means of endovascular treatments. Despite the type and stage of Pediatric neurovascular diseases, they should be treated in the center equipped with good infrastructure with neccessary attention of professionals including pediatric neurosurgeons.

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Pediatric neurovascular diseases are not common in children but they are widespread in adults. Therefore, only a small fraction of pediatricians specialize in this field of clinical practice. The manner in which Neurovascular diseases affect the nervous system of children is different from the effect it has on adults Thus managing problems connected to these types of deseases proves to be a challenge to both pediatrics and adult specialists. The author highlighted various types of treatment administered on the different forms of PNDs under multidisciplinary setting. Each case study highlighted the different diagnostic steps and treatment administered to the patients and the outcomes.

Similar to conventional occupational and physical therapies, Pediatric neurovascular diseases lack coordinated and multidisciplinary surgeon’s attention as the author proposes. Similarly, lack of sufficient data on most PNDs means that health care providers are not well experienced in handling such cases in a proper way. In addition, lack of funds by the patient’s family means that some PND patients don't have an opportunity to receive quality treatment in fully equipped facilities under the care of multidisciplinary health care professionals. Ischemic stroke is rare in clinical practice , thus it is often confused with other ailments. Therefore it is important that medical professionalsare equipped with sufficient knowledge of this rare PND and the most recent studies on patient rehabilitation techniques conducted needed to offer better treatment services.

Conclusion

In conclusion, the treatment of Pediatric neurovascular disease should take place under the management and coordination of multidisciplinary neurosurgeons and frequent intervention of pediatricians and neuro-radiologists. The study is not valid in evidence based practice due to the lack of resources such as finances, equipment and medical personnel.

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