Cognitive and functional status after vein of Galen aneurysmal malformation endovascular occlusion

Abstract

AIM:To study the clinical outcomes of treating vein of Galen aneurysmal malformations (VGAM), we assessed our patient cohort using standardized cognitive and functional measures. METHODS:A retrospective review of patients with VGAM treated by a single practitioner between 2003 and 2009 was performed for this study. In addition to routine clinical assessment, all patients were evaluated for cognitive and functional impairment using validated measures including the Neurobehavioral Rating ScaleRevised, the Bicêtre outcome score, and the Barthel index. RESULTS:Five patients underwent combined transarterial and transvenous embolization of their VGAM during the study period. VGAMs were classified based on angioarchitecture as either choroidal (1/5) or mural (4/5) according to the classification scheme of Lasjaunias. In total, 13 embolization procedures were performed consisting of 1 to 3 treatment stages per patient. Complete or near complete occlusion was achieved in 4 patients, while subtotal occlusion was achieved in 1 patient. �uring follow-up (median 62.6 mo), all patients were either unchanged or cognitively and neurologically intact.CONCLUSION: VGAM can be safely and effectively treated by staged transarterial and transvenous embolization. Using this strategy, excellent long-term cognitive and functional outcomes can be achieved.

Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis

“…3,12,40 The results suggest that advances in endovascular treatment have greatly improved the outcome of patients with VGAMs. However, what is the outcome for endovascular treatment?…”

“…The literature search identified a total of 34 studies, [3][4][5][6][7][8][9][12][13][14][15]17,20,[22][23][24][25]28,30,[32][33][34][35][36][37][38][39][40][41][42]45,46,50,51 which included 667 patients whose VGAMs were treated by endovascular embolization (Fig. 1).…”

Neurocognitive improvements following endovascular repair of vein of Galen malformation in a child

“…18 Despite advancements in treatment approaches, only a limited number of reports have examined the neurocognitive outcomes specifically associated with VGAM. 8,10,18,20,27 On the basis of retrospective chart review and parent questionnaires, Fullerton et al 10 reported that 39% of surviving patients presented with significant developmental delays, with worse outcomes associated with perinatal presentation, congenital heart failure, and choroidal angioarchitecture. Similar rates of cognitive impairment have been reported by other groups using various assessment measures, including the Bicêtre outcome score.…”

“…Similar rates of cognitive impairment have been reported by other groups using various assessment measures, including the Bicêtre outcome score. 18,20 More recently, Ellis et al 8 examined the cognitive and functional status of a small cohort of patients (n = 5) during the most recent postembolization follow-up appointment (range 2-97 months, median 63 months). A majority of patients (n = 4) were reported to be neurologically intact without any cognitive deficits, whereas 1 patient was noted to display premorbid deficits that were unchanged and continued to persist after embolization.…”

Advances in the diagnosis and management of vein of Galen malformations

“…Subtotal obliteration with clinically insignificant residual malformation was achieved in another 23%. Others have reported total or near total obliteration (90-100%) with variable morbidity and mortality in 39-80% of patients [2,18,20,77,96,97]. In 2006 Gupta et al [2] and Lasjaunias et al [18] reported complete occlusion in 66% and 55% of patients respectively.…”