Arteriovenous fistulas of the Vein of Galen region in adults: Endovascular treatment

Abstract

Purpose Arteriovenous fistulas of the Vein of Galen region in adults (Ad-VGAVF) are an uncommon entity with specific anatomic features. The aim of this article is to present our experience in the endovascular treatment of this pathology and to propose a therapeutic strategy based precisely on the angioarchitecture of these lesions. Materials and methods During a 20-year period, 10 patients underwent endovascular treatment of Ad-VGAVF. They were nine men and one woman with a mean age of 50 years (23–66 years) treated with the same embolization strategy. Clinical presentation, angiographic characteristics, therapeutic strategy, and clinical outcomes were recorded. Results All patients were treated exclusively by endovascular approach. Transarterial access was performed in eight patients and combined transvenous and transarterial access in two. Complete obliteration of the fistula was obtained in all patients. There were no intraprocedural complications. Post-embolization neurological symptoms occurred in 5 of 10 with complete resolution at six months in all of them. Conclusion Arteriovenous fistulas of the Vein of Galen region in adults present uniform angioarchitecture despite their low prevalence. Based on this constant angioarchitecture and especially on the features of its venous drainage, judicious embolization strategy is feasible and effective. Ten cases treated entirely by endovascular approach with excellent clinical and angiographic outcomes show this treatment like a curative alternative for this entity of deep topography and severe prognosis.

Pial arteriovenous fistula associated with vein of Galen dilatation in adult: A case report and MRI findings

“…The dilated venous pouch of the VOGM is located midline in the Galen region, receives a bilateral and usually symmetrical arterial supply from the choroidal arteries and subependymal network originating from the posterior circle of Willis. Some anatomical variations commonly associated with VOGM include presence of occipital and marginal sinuses, absence of straight sinus with persistent falcine sinus, and persistent limbic arterial arch [5] , [6] , [7] , [8] , [9] . This patient in our study had an arteriovenous fistula that was fed by the pial branches from left PCA and drained into the left medial atrial vein before joining the VOG confluence and causing VOG dilatation.…”

Adult dural arteriovenous fistulas in Galen region: More to be rediscovered

“…Third, complete fistula embolization should be performed while conserving the patency of the DVS as much as possible. Excessive venous occlusion could be the main reason for unexpected complications such as progressive thrombosis and venous-related infarcts post-embolization ( 6 ). As the cautionary case in Figure 2 shows, although there were no inappropriate steps throughout the embolization procedure, the postoperative angiography suggested the intravenous outflow time of contrast agent was delayed, which might indicate excessive embolization.…”

“…AGDAVFs are the most complex type of DAVF, and are difficult to manage because of their deep location and unusual vascularity. Except for some case reports or series, aGDAVFs have seldom been reported as a separate type of DAVF, and there was no specific management guidance on aGDAVFs from the endovascular treatment perspective (6). In Lawton's work, as a type of tentorial DAVFs, seven cases of DAVF at the Galenic region were reported, which were removed by surgery (7).…”

Diagnostik und Behandlung von duralen AV-Fisteln

“…2 b ). Diese Fisteln haben nicht selten auch eine piale Mitversorgung, was die Behandlung deutlich erschwert 15 . Sie sind nicht zuletzt durch das Vorhandensein des Sinus rectus bzw.…”