Paediatric interventional neuroradiology: The 10-year Queensland Children's Hospital experience, from conception to the future

Abstract

Learning Objectives: Provide an overview of the development and current status of the Paediatric interventional neuroradiology (PINR) service in Queensland, with a focus on the clinical challenges and variety of treated conditions. Background: PINR is an esoteric but developing field both within Australia and worldwide. PINR involves endovascular treatment of cerebrovascular diseases and unlike adult INR, mostly treats congenital pathology, including Vein of Galen aneurysmal malformations (VGAM) and arteriovenous malformations (AVM). Some treated conditions almost exclusively present in children including VGAM and dural sinus malformation (DSM), whilst others such as intracranial aneurysm occur in both adult and paediatric populations, but from varied pathology. PINR caseload is low because of the superspecialised nature of PINR alongside the relative rarity of relevant pathology. Consolidation of cases at a single centre is recommended internationally to ensure appropriate clinician expertise and multidisciplinary support. Before the pandemic, complex PINR patients in Queensland were transferred to the Royal Children's Hospital (RCH) in Melbourne, and ad hoc PINR procedures were offered at QCH in collaboration with RCH. Unprecedented circumstances demanded development of high-level intervention for some patients more locally, whilst maintaining consistent interstate partnership to ensure safe and effective care. Both diagnostic and interventional procedures at QCH have steadily increased over the last decade, with the highest numbers to date seen in 2024, and continued growth projected in 2025. In this retrospective review, we consider the unique challenges encountered in the growth and development of a comprehensive statewide PINR service, as well as potential future opportunities. As QCH reaches its 10-year anniversary in 2025, the PINR service has grown in parallel, evolving from ad hoc, infrequent intervention into a consistent high-level service with interstate and international multidisciplinary collaboration, treating high risk and complex patients. Procedure Details: We will showcase imaging findings and procedure details from specific cases including VGAM, DSM, intracranial aneurysm, AVM and dural arteriovenous fistula (DAVF) to demonstrate the similarities and differences between paediatric and adult INR alongside the risks and benefits of intervention in these complex conditions. We also consider the reasons for, and challenges faced by, the evolution of the service over time. Conclusion: PINR can provide lifesaving treatments options for patients with no other recourse. The Paediatric Interventional Neuroradiology Service at the Queensland Children's Hospital has significantly evolved since 2015, now treating a wide array of complex patients. Unique challenges are posed by the superspecialised nature of PINR and disease rarity..