1. To learn about the most common causes for image-guided intervention in children.
2. To understand how the practical and technical approach to intervention in a child differs from that in adults.
3. To appreciate tips, tricks and pitfalls in paediatric intervention procedures.
Interventional radiology (IR) procedures are a vital part of paediatric care for most complex diseases, providing reliable intravenous access and feeding tube support during intensive therapy such as chemotherapy and delivering innovative minimally-invasive therapies for other conditions to avoid surgery and often save lives. Central venous access in children can be technically challenging but is quicker and less invasive than open surgical techniques, and there is evidence to suggest that the central veins are preserved for longer, which is key in children with chronic disease. Angiography in children is usually straightforward, with just a few important technical points to remember in small children. Looking beyond central venous access, paediatric IR delivers therapies such as sclerotherapy for vascular malformations, percutaneous nephrolithotomy (PCNL) for renal stone extraction, oesophageal dilatations to manage oesophageal strictures and biopsy to safely and accurately stage childhood tumours. As with all of IR, the key to safe and successful practice is an understanding of the different pathology processes in children and the underlying decision making processes involved in delivering best practice.
1. To learn about the classification of paediatric vascular malformations.
2. To understand the diagnostic work-up and the indications for percutaneous treatment of paediatric vascular malformations.
3. To appreciate the treatment options for different vascular malformations.
Diagnosis and treatment of vascular malformations in children is a combination of different diagnostic tools adapted to the given clinical setting. It always has to be an interdisciplinary team approach mostly based in dedicated centres to first find the correct diagnosis and then decide whether or not treatment is necessary. From the clinical background, most vascular malformations don’t need invasive treatment because they do not cause any symptoms. However, the clinical decision has to be based on a reliable diagnosis, and different imaging pathways have to be considered. Imaging is predominantly performed by Ultrasound and MRI. Valuable information is added by clinical examination and history as well as sometimes histopathologic specimens. Different MRI examination approaches exist that help to find the correct diagnosis in the end. In imaging, it is important to distinguish between high-flow lesions e.g. arteriovenous malformations (AVM) or low-flow lesions e.g. venous malformations. Ultrasound and MRI can help to look beyond the focal vascular malformation because other body-regions might be affected as well. The correct diagnostic workup will help to define the right clinical pathway in a multidisciplinary team discussion. The treatment decision should then include non-interventional procedures such as physiotherapy or compression hosiery as well as interventional procedures such as sclerotherapy, embolization and surgery. It is essential to talk to and support the children and their parents, so they understand the different pathways and options. When all this comes together, they can decide well-informed leading to a hopefully satisfied patient in the end.
1. To learn how to diagnose, and how to treat, osteoid osteomas.
2. To understand the techniques for percutaneous treatment of osteoid osteoma: preparations, procedure and follow-up.
3. To appreciate advantages and potential complications in percutaneous treatment of osteoid osteoma in children.
Osteoid osteoma is a benign inflammatory bone tumour encompassing 2-3% of all bone tumours and 10% of benign bone tumours; it is most common in males < 25 years of age with patients typically complaining of pain that worsens at night and is promptly relieved by salicylates. A tumour was first reported by Jaffe in 1953; osteoid osteoma is composed of the nidus which is bone at various maturity stages surrounded by highly vascular connective tissue stroma. Depending on the location and axial imaging findings, osteoid osteoma can be classified into subperiosteal, intracortical, endosteal or intramedullary and intra-articular with the latter being the least common type and refers to lesions located within or near a joint. The application of radiofrequency ablation (RFA) was introduced in clinical practice by Rosenthal in 1992 performing a percutaneous approach for the treatment of osteoid osteoma. Nowadays thermal ablation of osteoid osteoma constitutes a first-line therapy. Numerous studies upon all ablation techniques, others with lesser and others with higher numbers of patients report high pain reduction rates (up to 96%) and low recurrence rates (~7% at two years). Comparing percutaneous ablation to the traditional surgical techniques for osteoid osteoma (wide excision removing a bone block, marginal resection of the entire nidus, curettage or high-speed burr techniques) favours a percutaneous approach in terms of minimum trauma, minimum functional restriction and significantly lower cost.