BACKGROUND AND PURPOSE: Neurointerventions in children have dramatically 
improved the clinical outlook for patients with previously intractable 
cerebrovascular conditions, such as vein of Galen malformations and complex 
arteriovenous fistulas. However, these complex and sometimes lengthy procedures 
are performed under fluoroscopic guidance and thus unavoidably expose vulnerable 
pediatric patients to the effects of ionizing radiation. Recent epidemiologic 
evidence from a national registry of children who underwent CT scans suggests a 
higher-than-expected incidence of secondary tumors. We sought to calculate the 
predicted risk of secondary tumors in a large cohort of pediatric 
neurointerventional patients.
MATERIALS AND METHODS: We reviewed our cohort of pediatric neurointerventions, 
tabulated radiation dose delivered to the skin, and calculated the range of 
likely brain-absorbed doses by use of previously developed mathematical models. 
The predicted risk of secondary tumor development as a function of 
brain-absorbed dose in this cohort was then generated by use of the head CT 
registry findings.
RESULTS: Maximal skin dose and brain-absorbed doses in our cohort were 
substantially lower than have been previously described. However, we found 1) a 
statistically significant correlation between radiation dose and age at 
procedure, as well as number and type of procedures, and 2) a substantial 
increase in lifetime predicted risk of tumor above baseline in the cohort of 
young children who undergo neurointerventions.
CONCLUSIONS: Although neurointerventional procedures have dramatically improved 
the prognosis of children facing serious cerebrovascular conditions, the 
predicted risk of secondary tumors, particularly in the youngest patients and 
those undergoing multiple procedures, is sobering.