Cerebrovascular Surgery and Interventions Center

At the Boston Children’s Hospital Cerebrovascular Surgery and Interventions Center we care for children and young adults with cerebrovascular disease (CVD). This is a group of conditions that affect the blood vessels in and around the brain and spine.

While CVD occurs in people of all ages, the conditions that affect children are often different from those seen in adults. Children with CVD face the risk of bleeding (hemorrhage) or of too little blood supply (ischemic stroke), conditions that can cause serious harm to the brain.

Our center uses a full range of surgical intervention and interventional radiology techniques to treat these conditions, ideally before they cause serious brain injury. We have adopted and modified many of these tools from those originally developed for adults.

 

Our depth of experience in cerebrovascular disease

Center co-directors, pediatric neurosurgeon Edward Smith, MD, and neurointerinventionalist Darren Orbach, MD, PhD, are internationally-recognized leaders in pediatric CVD. The Cerebrovascular Surgery and Interventions Center treats more children with CVD than any other center in the world, including rare childhood disorders not seen elsewhere. Our team sees the highest number of patients for neuroangiography and embolization with the lowest rate of complications. We are also the highest volume center for surgical revascularization in patients with moyamoya disease, with the shortest length of stay and best outcomes. In addition, our center has been recognized as a Center of Excellence by the Angioma . Since the center launched in 2014 we’ve performed more than 1,800 surgeries.

 

Why choose the Cerebrovascular Surgery and Interventions Center?

Our patients receive care from a collaborative, highly experienced team, including a pediatric neurosurgeon, a dedicated neurointerventional radiologist, and clinicians with expertise in childhood neurologyneurocritical care, neuroanesthesia, diagnostic neuroradiology, strokevascular anomalies and blood disorders. We also have a dedicated nurse practitioner and program coordinator to help guide familes before, during and after surgery. Together, our goal is to provide a seamless, team-based, patient-focused approach. We also offer centralized scheduling for visits to other departments and clinics at Boston Children’s during your child’s hospital stay.

Because we provide the entire spectrum of CVD treatment options — surgery, radiation and embolization — we’re able to provide the best care plan for each child. This means minimizing invasive procedures and radiation exposure wherever possible. Most importantly, we are not adult-oriented physicians who also treat children: our entire center is focused on children and young adults.

 

Pioneering procedures

Many of the interventions used at Boston Children’s, such as pial synangiosis for moyamoya were first developed and tested here. In many cases, we have modified devices and techniques typically used to treat adults to ensure their effectiveness and safety in children.

 

Science-driven care

Physicians in the Cerebrovascular Surgery and Interventions Center are among the most published in the world (see our selected publications). The goal of our research is to improve the diagnosis and treatment options for CVD in children. Through research, we have built a large database that guides and informs our practice and helps us innovate.

Doctors Edward Smith (left) and Darren Orbach (right), co-directors of the Cerebrovascular Surgery and Interventions Center.

Our co-directors have also authored and contributed to professional guidelines for stroke and other CVDs, as well as the American Heart Association’s Guidelines for the Management of Cerebrovascular Disorders in Infants and Children. Our own understanding of the risks involved in certain procedures has led to improved patient safety, and has greatly improved our treatment options. This has led to better outcomes. For example, our patients with moyamoya have only a 4.5 percent stroke risk over five years after treatment. This is one of the best rates in the field.

Research has also allowed us to reduce radiation doses for children, discover clinically relevant biomarkers that reduce complication rates and to explore urine testing as a way to monitor conditions like moyamoya disease and arteriovenous malformations (AVMs). We also collaborate actively with scientists around the world to better understand rare types of CVD and identify genetic causes of these conditions. Our research efforts range from new technical approaches in the hospital to benchtop laboratory science in our Vascular Biology Program, the largest pediatric vascular research institute in the United States.

Read more on our Innovation and Research page.