Vascular Diseases of the Brain and Spinal Cord

In children, these are the most common conditions that affect the blood vessels of the brain and spinal cord: 

• Aneurysm (ANN-yer-iz-im) is a wide spot in an artery, like a bubble. It usually develops from a weakness in the wall of an artery.
• Arteriovenous malformation is a tangle of small, abnormal blood vessels. It is pronounced are-TEAR-io-venus malformation. Small blood vessels (capillaries) are missing, so blood flows directly into veins at high pressure. This can also make blood vessels swell, burst and bleed. The condition is also called AVM.
• Cavernous malformation is a tightly packed cluster of tiny blood vessels (capillaries) with walls that are thinner, weaker and less elastic than normal. A child can have more than 1 malformation. The condition is also called cavernous hemangioma, cavernous angioma and cavernoma.
• Moyamoya (pronounced MOY-a-MOY-a) is a problem with blood flow to the brain. It happens when the major blood vessels in the brain (internal carotid arteries) become narrower.
• Vein of Galen malformation happens because of an abnormal connection between arteries and veins deep in the brain. This causes a ballooning (aneurysm) in a blood vessel called the vein of Galen. This is a rare malformation. We see 2 or 3 babies a year with a vein of Galen malformation.

What causes vascular diseases?

Doctors don’t know for sure what causes these abnormalities. Sometimes they happen because of changes in genes passed down from a parent to a child.

• Seattle Children’s is the only hospital in the Pacific Northwest with a well-developed program to treat children who have problems with blood flow in the brain. Experts at our Pediatric Vascular Neurology Program will care for your child.
• Dr. Catherine Amlie-Lefond is a national leader in treating children who have problems with blood vessels in their brains. She is a pediatric vascular neurologist and directs our Pediatric Vascular Neurology Program.
• Children come here from across the country for surgery called pial synangiosis (PEE-ul sin-an-JOE-sis) to improve blood flow to their brain. Dr. Richard G. Ellenbogen performs many of these operations every year.
• If your child's condition causes seizures, their treatment options may include laser ablation surgery. Dr. Jeffrey Ojemann, our Neurosurgery chief, has been performing laser ablation since 2013. Seattle Children's was among the first in the nation to offer this treatment.
• Our neurosurgeons have some of the best outcomes in the nation for surgery to improve blood flow to the brain (revascularization surgery).
• Seattle Children’s doctors pioneered using medical-grade Super Glue to make it safer and easier to remove venous malformations (VMs). It is now our standard of care for certain types of VMs in the head and neck.
• If your newborn is critically ill due to a vascular disease of their brain, we provide specialized care in our Neuro NICU – the only neonatal neurocritical care program in Washington, Wyoming, Alaska, Montana and Idaho.

Each child’s case is unique. Based on your child’s needs, their team may include specialists in:

• The nervous system (neurosciences)
• Using radiology or X-rays to diagnose and treat children (interventional radiology)
• Evaluating learning, memory and mood (neuropsychology)
• Pharmacy
• Social Work
• Rehabilitation Medicine
• Eye problems (ophthalmology)
• Emergency care
• Critical Care Medicine

Some conditions affecting the blood vessels of the brain cause seizures. Seattle Children’s has the largest pediatric Epilepsy Program on the West Coast. It is the only pediatric program in the Northwest that is accredited level 4 by the National Association of Epilepsy Centers (NAEC).

At Seattle Children’s, we care for babies, children and teens who:

• Have symptoms but have not been diagnosed
• Have been diagnosed and need treatment
• Had surgery somewhere else and want to change doctors
• Want a second opinion about the best treatment
• Need follow-up care to have the best quality of life

Vascular diseases can be life threatening. Your child may arrive at Seattle Children’s very ill from bleeding due to a problem in the blood vessels.

• Our Emergency Department provides immediate care 24 hours a day, 7 days a week for babies, children and teens who need it.
• Seattle Children’s is the only hospital in the region with round-the-clock, on-site coverage by a pediatric neurosurgeon.
• We have a Pediatric Intensive Care Unit (ICU) and the first Level IV Neonatal ICU in the state.

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. If your child has another condition that is linked with their vascular disease, team members work together and with you to develop the best treatment plan to take care of all of your child’s health needs.

• Children don’t react to illness, pain, medicine and surgery in the same way as adults. They need – and deserve – care designed just for them. They need a healthcare team specially trained to understand and meet their needs.
• Our doctors have special training to diagnose and treat children. They are focused on how today’s treatment will affect your child as they develop and become an adult.
• Our experts base their treatment plans on years of experience and the newest research on what is best for children and teens.
• We meet your child’s changing needs, whether they are a youngster going back to school after brain surgery or a teen taking more responsibility for their health.

• 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.
• Our doctors, nurses, child life specialists and social workers help your child and your family through the challenges of their condition. We connect you to community resources and support groups.
• At Seattle Children’s, we work with many 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.
• As your child gets older, we prepare them to take on a greater role in their own care. When they become adults, we help them transition to care at Harborview Medical Center.

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 when 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 cavernous malformations vary from child to child:

• They may come on slowly or quickly.
• Symptoms may come and go as the cavernous malformation bleeds and then the body absorbs the blood.
• Some children only have symptoms caused by a bleed once.
• Some have frequent rebleeding and symptoms that get worse.

Symptoms of cavernous malformations in the brain include:

• Seizures
• Headaches
• Weakness or paralysis in arms or legs
• Vision problems
• Hearing problems
• Speech problems
• Balance problems
• Thinking, memory and attention problems

Read more about 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.

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

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.
•  If coils or particles are used, they block the blood supply and cause the blood vessels to clot. This makes it easier to remove the tangled clumps of extra veins.

Read how Super Glue makes removing venous malformations easier and less risky

We sometimes use the gamma knife process to treat abnormal spots in 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 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 one of only 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.

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 removes a piece of bone from the skull.
• Cuts 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 and closes up the skull. If possible, the skull is closed using the same piece of bone that was removed. Sometimes the surgeon uses hardware such as micro plates, screws and wires to close the skull.

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 one part of the body to another to create a channel for blood flow.

There is no medicine to get rid of vascular malformations. But medicines may help ease symptoms caused by cavernous malformations, including:

• Headaches
• Seizures

Seattle Children’s Epilepsy Program is the largest program on the West Coast dedicated to treating children with seizures. Our doctors, nurses and other specially trained staff are experts at understanding childhood epilepsy and finding the most effective treatment for your child.

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 thorough 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 (AVM)
• Cavernous malformations

Doctors treat moyamoya with surgery to bring new blood supply to the brain. Your child’s team at Seattle Children’s will also recommend steps to help reduce risk of stroke.

Children come here from across the country for surgery called pial synangiosis (PEE-ul sin-an-JOE-sis) to improve blood flow to their brain. Dr. Richard G. Ellenbogen performs many of these operations every year on babies, children and teens.

Pial synangiosis is a type of revascularization surgery. It creates a way for more blood to get to the brain. Neurosurgeons free part of the superficial temporal artery (STA) from your child’s scalp. Then they open your child’s skull and attach the artery onto the surface of their brain. New vessels grow from the artery down into the brain and increase blood flow to the area.

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

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 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 to transition to adult care, we connect them with experts who can meet their adult healthcare needs.

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