Vein of Galen Aneurysmal Malformation : Endovascular Management of 6 Cases in a Single Institute

Abstract

Objective : The aim of this study was to analyze the treatment outcome of patients with vein of Galen aneurysmal malformations (VGM). Methods : Clinical and angiographic data of six consecutive patients with VGM were retrospectively reviewed. VGMs were angiographically classified by Yasargil's method. Treatment outcomes were evaluated. Results : Mean age at initial treatment was 4.4±5.7 months. Angiographic types of VGMs were type II in two patients and type III in four. Three patients had cardiac symptoms and the others were asymptomatic. Two patients were treated with transvenous embolization, three with transarterial embolization, and one was managed conservatively. Two patients died due to venous hypertension few days after transvenous approach. Of three patients who were transarterially embolized, one was completely occluded with Onyx and two were incompletely occluded. During the follow-up period (range, one to six years) two of three patients treated with transarterial approach were asymptomatic and the other showed mild symptoms. One patient who was managed conservatively showed normal performance. Conclusion : Transarterial embolization of VGMs may be better than transvenous approach in terms of the treatment outcome and complication. Further studies are needed because of the rarity of the disease and rapid advancement of endovascular techniques.

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

“…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).…”

Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis

“…V ein of Galen arteriovenous malformations (VOGMs) are shunts that form in utero between the choroidal arteries and the precursor of the vein of Galen, the median prosencephalic vein of Markowski. [1][2][3] Current prevalence estimates of VOGM are quite low, often cited at Ͻ1 of 25,000 deliveries. 4,5 A number of studies have shown that the natural history of VOGMs is very poor, with many patients succumbing to complications related to congestive heart failure (CHF), hydrocephalus, and brain parenchymal injury.…”

“…Endovascular embolization of VOGMs has emerged as a standard of care in this patient population; however, long-term outcomes after endovascular embolization, as well as predictors of good neurologic outcomes, are still poorly understood. [2][3][4] Thus, to assess the status of endovascular treatment for VOGMs, we performed a systematic review and meta-analysis with an emphasis on determining factors associated with good neurologic outcome in this patient population.…”

The natural progression of VGAMs and the need for urgent medical attention: a systematic review and meta-analysis

“…Patient clinical outcomes were analyzed in the 19 studies in which spontaneous thromboses occurred (see online supplementary table S6) 4 20 21 25 26 42–55. Online supplementary table S7 presents the clinical outcome of patients with spontaneous thromboses for various age groups.…”