Adjuvant Coil Assisted Glue Embolization of Vein of Galen Aneurysmal Malformation in Pediatric Patients

Kim, Dong Joon; Suh, Dae Chul; Kim, Byung Moon; Kim, Dong Ik

doi:10.5469/neuroint.2018.13.1.41

Cited by 13 publications

(10 citation statements)

References 19 publications

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“…Open surgery and transtorcular approaches have been shown to have significant morbidity and mortality [11,12]. Most current treatments focus on endovascular therapies, particularly transarterial approaches with embolization with N-butyl-cyanoacrylate or onyx liquid (ethylene vinyl alcohol copolymer delivered in dimethyl sulfoxide) solvent as well as in combination with coils [3,13,14]. The extreme flow through these vascular lesions, however, poses some limitations on the arterial approach such as unintended passing of embolic material through the fistula causing catastrophic occlusion of sinuses or permeation into normal tissues.…”

Section: Discussionmentioning

confidence: 99%

Transvenous Pressure Monitoring Guides Endovascular Treatment of Vein of Galen Malformation: A Technical Note

et al. 2021

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Introduction: Vein of Galen malformations (VGMs) are complex congenital arteriovenous malformations that generally require serial endovascular treatment sessions to slowly correct the high-flow fistulous connections that cause increased venous pressures and ultimately lead to the classic presentations of heart failure, hydrocephalus, and intracranial hemorrhages. Despite the advances in endovascular technology and embolic materials, the resolution of embolization is often limited to the subjective view of diminished flow on angiograms. Case Report: An 8-month-old patient with a VGM developed clinical signs of heart failure and growing head circumference with ventriculomegaly. The patient was treated endovascularly with a transvenous approach for coil embolization while undergoing continuous monitoring of the post-malformation venous pressures. The arterial and venous systolic blood pressures (SBP) were collected at serial time points and used to measure estimated 95% confidence interval bounds for arteriovenous SBP gradients and determine when sufficient coil embolization and flow reduction was thought to be achieved. Conclusion: The transvenous pressure monitoring demonstrated progressively increasing pressure gradients between the arterial and venous systems that correlated with the degree of flow reduction on angiographic runs. The patient underwent successful coil embolization of the VGM and had improvement of heart failure and ventricular size in follow-up at 8-month post-op. This provides a novel technique to introduce an objective measurement that can guide the embolization of a VGM.

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Section: Discussionmentioning

confidence: 99%

Transvenous Pressure Monitoring Guides Endovascular Treatment of Vein of Galen Malformation: A Technical Note

et al. 2021

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“…8 Similarly, treatment of pial arteriovenous fistula (AVF) and fistulous points of nidal AVMs have been thus far dependent on carefully controlled injections of n-butyl cyanoacrylate, [9][10][11][12] which although effective, have a significant risk profile. 12 Using long sheaths in these cases enables precise embolization via the use of microballoons, 13,14 or proximal coiling 15,16 prior to liquid embolic injection, without the need for second femoral arterial access. This not only increases the efficacy of shunt closure, but enables a degree of technical control which enhances procedural safety.…”

Section: Discussionmentioning

confidence: 99%

Long Vascular Sheaths for Transfemoral Neuroendovascular Procedures in Children

Dmytriw¹,

Ha²,

Bickford³

et al. 2021

Neurointervention

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Purpose: To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children.Materials and Methods: A retrospective evaluation of transfemoral neuroendovascular procedures in children <18 years, using long sheaths was undertaken analyzing procedure type, fluoroscopic times, technical success, access site and systemic complications. Twenty-seven consecutive procedures were included over a two-year period. Mean age was 8.4 years (standard deviation [SD] 6.3) (range 17.0 months–16.3 years).Results: Patients were 44% female and mean weight was 35.0 kg (SD 22.8) (range 9.8–72.2 kg). A third of the procedures were performed in ≤15 kg children. The most common procedure was for embolization (n=13, 48.1%) and the most common indication was dual microcatheter technique (52%). The most common device used was the 5 Fr Cook Shuttle sheath. Mean fluoroscopy time was 61.9 minutes (SD 43.1). Of these procedures, 93% were technically successful. Femoral vasospasm, when present, was self-limiting. Complications (3/27, 11.1%) included groin hematoma (n=1), neck vessel spasm that resolved with verapamil (n=1), and intracranial thromboembolism (n=1), with no significant difference between the ≤15 kg and >15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications.Conclusion: Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionalist.

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“…Spinal AVM and/or fistula may have similar aspects but different development compared to the intracranial dura [ 30 ]. Vein of Galen aneurysmal malformations (VGAMs) and dural sinus malformations are specific forms of dural AVFs, which are developmental anomalies accompanied by venous sinus malformation that can be found antenatally [ 6 31 32 ]. These malformations are largely sporadic, possibly due to an early insult such as somatic mutations [ 31 ].…”

Section: Composition Of An Rnvd Panel and Prevalence Of Each Disease In Koreamentioning

confidence: 99%

Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants

et al. 2021

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Rare neurovascular diseases (RNVDs) have not been well-recognized in Korea. They involve the central nervous system and greatly affect the patients' lives. However, these diseases are difficult to diagnose and treat due to their rarity and incurability. We established a list of RNVDs by referring to the previous literature and databases worldwide to better understand the diseases and their current management status. We categorized 68 RNVDs based on their pathophysiology and clinical manifestations and estimated the prevalence of each disease in Korea. Recent advances in genetic, molecular, and developmental research have enabled further understanding of these RNVDs. Herein, we review each disease, while considering its classification based on updated pathologic mechanisms, and discuss the management status of RNVD in Korea.

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Adjuvant Coil Assisted Glue Embolization of Vein of Galen Aneurysmal Malformation in Pediatric Patients

Cited by 13 publications

References 19 publications

Transvenous Pressure Monitoring Guides Endovascular Treatment of Vein of Galen Malformation: A Technical Note

Transvenous Pressure Monitoring Guides Endovascular Treatment of Vein of Galen Malformation: A Technical Note

Long Vascular Sheaths for Transfemoral Neuroendovascular Procedures in Children

Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants

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