Innovation and research

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cerebrovascular innovations
A 3D model of an arteriovenous malformation, which was used for surgical planning, from an actual patient who was treated successfully.

The Center conducts ongoing research to improve diagnostic and therapeutic approaches to cerebrovascular disease (CVD) in children.  (See a sampling of our publications.) As we develop and implement new techniques, we update an extensive database that guides and informs our practice and helps us innovate. Our clinical research is complemented by basic science discoveries in the Vascular Biology Program.

 

New techniques 

3D printing to model brain and vascular anatomy

Working with Peter Weinstock, MD, PhD, of the Simulations group at Boston Children’s, Edward Smith, MD, and Darren Orbach, MD, PhD, are pioneering the creation of precision 3D models of individual patients’ brains and blood vessels, using the data from their brain scans. These models, created with special digitally guided printers that lay down different types of molten plastic in precision fashion, can be used to plan and rehearse surgical and neurointerventional maneuvers in advance. Read more.

New surgical treatments

Our neurosurgical team has developed surgical treatments for pediatric cavernous malformations. For children with moyamoya disease, we developed an operation known as pial synangiosis. It stimulates new blood vessels to grow in the brain and has been shown to be safe and effective in reducing stroke risk in children with moyamoya disease. Learn more.

Refining catheter procedures

A variety of novel techniques developed and trialed here have allowed safe use of catheters and endovascular devices in infants’ tiny vessels. Read more here and here.

We also successfully adopted Onyx®, an improved material used in the embolization of cerebrovascular lesions in adults, to treat cerebral and spinal arteriovenous malformations, vein of Galen malformations and dural arteriovenous fistulae in children. We have more experience using Onyx® in children than any other center, with an unparalleled safety record.

 

Practice advances

  • Our physicians played a key role in developing the current American Heart Association (AHA) guidelines for stroke management in children, and authored AHA guidelines for AVM and moyamoya disease.
  • Advances in understanding the risk for brain hemorrhage in children with AVMs have improved our selection of treatment options.
  • New techniques have dramatically improved safety and reduced children’s radiation exposure during neurointerventions. Working closely with fluoroscopy equipment vendors to adjust and optimize technical factors, we have demonstrated that it is possible to achieve high-quality imaging at low radiation doses.

 

Ongoing research

CVD biomarkers

Neurosurgeon Edward Smith, MD, is beginning to identify telltale proteins in the urine of patients with cerebrovascular disorders, such as moyamoya disease and arteriovenous malformations. These “biomarkers” may help in diagnosing and monitoring CVD, reducing the need for children to travel to Boston Children’s for follow-up imaging studies. Dr. Smith has already validated the utility of urine biomarkers of several kinds of brain tumors. Read more.

CVD dynamic database

Our comprehensive patient database, representing the largest experience with pediatric cerebrovascular disease in the world, provides rich source material for ongoing studies. The database allows us to track long-term patient outcomes, compare the results of different surgical and neurointerventional procedures, evaluate newly adopted interventions and improve our quality of care.

For highlights of our previous research, see Selected Papers.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
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