Normal galenic drainage of the deep cerebral venous system in two cases of vein of Galen aneurysmal malformation

Lévrier, O.; Gailloud, Philippe; Souei, M. Mhiri; Manera, L.; Brunel, H.; Raybaud, C

doi:10.1007/s00381-003-0841-y

Cited by 42 publications

(11 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, Raybaud et al (the first to postulate that the venous collector in VOGM was the MPV and not the true vein of Galen) identified drainage of the ICVs into the MPV in 4 of 12 patients . Drainage of the ICVs to the MPV in some patients with VOGM has also been suggested by multiple authors since then using magnetic resonance venography, delayed-phase cerebral angiography, and retrograde transvenous angiography . More recently, time-of-flight magnetic resonance venography assessment (associated with cerebral angiography) of 55 patients with VOGM identified direct drainage of the ICVs to the venous sac in 15 patients (27.3%) .…”

Section: Discussionsupporting

confidence: 64%

“…3 Drainage of the ICVs to the MPV in some patients with VOGM has also been suggested by multiple authors since then using magnetic resonance venography, delayedphase cerebral angiography, and retrograde transvenous angiography. 2,17,18 More recently, time-of-flight magnetic resonance venography assessment (associated with cerebral angiography) of 55 patients with VOGM identified direct drainage of the ICVs to the venous sac in 15 patients (27.3%). 16 A logistic regression analysis in our series identified deep venous drainage to the MPV as a statistically significant predictor of poor outcomes after embolization (Table 3).…”

Section: Deep Cerebral Venous Infarction: Drainage Of the Icvsmentioning

confidence: 99%

“…There is convincing evidence from multiple studies demonstrating that in a larger than previously thought subset of patients with VOGM the deep veins can drain into the MPV and MRI time-of-flight venography can be useful to help identify such drainage. [1][2][3]5,[16][17][18] Identifying these patients may prevent catastrophic outcomes. We presume that the reason why this phenomenon has not been more widely recorded on angiography is associated with several factors: competitive flow from the fistulous components of the VOGM, arterial-phase predominant angiographic acquisitions after injection of contrast to minimize radiation dosage, contrast recirculation in the arteries masking venous channels, predominant focus of interventionists on the fistulae, and technological limitations of older angiographic equipment.…”

Section: Deep Cerebral Venous Infarction: Drainage Of the Icvsmentioning

confidence: 99%

See 2 more Smart Citations

Factors Contributing to Major Neurological Complications From Vein of Galen Malformation Embolization

et al. 2020

View full text Add to dashboard Cite

IMPORTANCEMajor neurological complications from the embolization of vein of Galen malformations (VOGMs) are poorly understood. We provide a detailed analysis of contributors to periprocedural neurological complications and lessons learned.OBJECTIVE To assess the rate of major periprocedural neurological complications following VOGM embolization with major procedural and strategic contributors. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted at a quarternary referral pediatric hospital (Hospital for Sick Children; Toronto, Ontario, Canada) from January 1999 to December 2018 with a mean clinical follow-up of 44.7 months; all children with VOGM diagnosed and/or treated were eligible (n = 48). Thirty-three patients who underwent endovascular treatment were included.INTERVENTIONS Endovascular staged transarterial embolization performed in 33 patients over 91 sessions. MAIN OUTCOMES AND MEASURESThe primary outcome was the rate of periprocedural neurological complications (occurring within 1 week of embolization). The secondary outcomes were mortality, long-term neurological outcomes, and contributing anatomical and management factors to neurological complications. RESULTSOf 33 patients who underwent embolization (31 boys [64.6%]; 17 girls [35.4%]; median age at first embolization, 4 months [range, 0-29 months]), 10 patients (30.3%) developed major periprocedural neurological complications. Five of these patients died. Univariate logistic regression analyses identified internal cerebral vein drainage to the main venous sac of the VOGM and use of a microcatheter with a distal outer diameter of more than 2.0F as significant predictors of poor neurological outcomes. Lessons learned from our experience include the need to assess the internal cerebral vein drainage pattern on preprocedural magnetic resonance venography, avoidance of excessive embolization into the venous sac, treatment of more distal fistulae before proximal fistulae to avoid a sump effect, and preferably use of smaller (<2.0F outer diameter) microcatheters in neonatal embolization procedures. CONCLUSIONS AND RELEVANCEIn this cohort, 10 patients with VOGM treated with embolization (30.3%) experienced major periprocedural neurological complications, half of whom died. While these outcomes are superior to historic conservative and surgical treatment results, ongoing improvements in treatment and pretreatment diagnostic approaches are needed. Awareness of the lessons learned from our experience can help to avoid similar complications in the future for this vulnerable population.

show abstract

Section: Discussionsupporting

confidence: 64%

Section: Deep Cerebral Venous Infarction: Drainage Of the Icvsmentioning

confidence: 99%

Section: Deep Cerebral Venous Infarction: Drainage Of the Icvsmentioning

confidence: 99%

See 1 more Smart Citation

Factors Contributing to Major Neurological Complications From Vein of Galen Malformation Embolization

et al. 2020

View full text Add to dashboard Cite

show abstract

“… 8 20 Classically, the deep venous drainage is not known to be connected to the vein of Galen but exceptions are reported. 2 8 21 22 Impairment of deep venous drainage or sudden congestion of subependymal anastomoses may cause hemorrhage in cases of complete venous occlusion with residual arterial feeders. 1 8 14 20 Thus, our intention was not to completely occlude the vein when coils were introduced into the vein of Galen but only to provide a scaffold for coil deployment in the distal feeder artery.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

PurposeAdjuvant coils may offer advantages in flow control during glue embolization of high flow vein of Galen aneurysmal malformation (VGAM) patients but involves specific issues such as feasibility, durability and coil mass effect. The purpose of this study is to assess the outcome of adjuvant coils in addition to transarterial glue embolization for treatment of these patients.Materials and MethodsFive pediatric VGAM patients (age range; 11 weeks to 2 yrs 2 mos) with high flow fistulous angioarchitecture were treated with adjuvant coils 1) in the distal feeding artery and/or 2) in the vein of Galen followed by glue embolization of the shunt. The angiographic / clinical outcomes were assessed.ResultsAdjuvant coils were deployed in the distal feeding artery (n=3), vein of Galen pouch plus distal feeding artery (n=2). Additional transarterial glue embolization of the fistulae was successfully performed (n=4). Complete occlusion was achieved with coils in one case. Complete occlusion was achieved for all mural type cases (n=4). Residual feeders remained in a case of choroidal type of VGAM. No complications were noted related to the treatment. All patients showed normal development on follow up (range: 7.6 to 88.8 mo, mean 49.3 mo). Initial hydrocephalus improved on follow up despite coil mass effect in dilated vein of Galen.ConclusionAdjuvant coils for flow control with glue embolization may be a safe and effective treatment method for VGAM patients with high flow fistulous feeders.

show abstract

“…Moreover, it is also possible that structures typical for early embryonic development such as falcine sinus become preserved, which may result in arresting the development of other sinuses, e.g. straight sinus [9,10]. …”

Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis of a vein of Galen aneurysmal malformation with MR imaging – report of two cases

et al. 2013

View full text Add to dashboard Cite

SummaryBackgroundVein of Galen malformations (VGMs) are rare congenital defects of cerebral vessels. They are formed between the 6th and 11th week of gestation. The background of this defect involves presence of one or more arterovenous fistulas directing bloodflow toward a persistent, dilated, proximal part of median prosencephalic vein (MProsV). Ultrasound examination is a basic test for diagnosis of VGMs. It has now become possible to acquire images of diagnostic value using magnetic resonance (MR) techniques.Case ReportThis work presents two cases of vein of Galen aneurysms diagnosed prenatally with magnetic resonance imaging. In both patients fetal CNS malformations were diagnosed in ultrasound examinations. MR imaging of the fetal head was performed for further diagnostics.ConclusionsBecause of the ability to precisely determine the size of the ventricular system, presence of raised intraventricular pressure and topographic relationships between pathologically changed vessels and particular cerebral structures as well as the presence of ischemic areas MR examination is currently not only complementary to ultrasonography, but is becoming an independent examination method in the diagnostics of vein of Galen malformations.

show abstract

Normal galenic drainage of the deep cerebral venous system in two cases of vein of Galen aneurysmal malformation

Cited by 42 publications

References 12 publications

Factors Contributing to Major Neurological Complications From Vein of Galen Malformation Embolization

Factors Contributing to Major Neurological Complications From Vein of Galen Malformation Embolization

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

Prenatal diagnosis of a vein of Galen aneurysmal malformation with MR imaging – report of two cases

Contact Info

Product

Resources

About