Vein of Galen malformation

Abstract

Since 1984, 43 patients with true vein of Galen aneurysmal malformations have been referred to us and managed according to our patient selection, technique, and follow-up guidelines. Thirty-four were embolized transarterially with bucrilate (isobutyl cyanoacrylate) or enbucrilate (N-butyl cyanoacrylate) embolization. No cutdown or hypotension during or after the embolization was used and no balloon catheter was employed. Forty-seven percent of the children had a completely occluded lesion which was confirmed when the child was at least 6 months of age at the follow-up angiographic examination; 52.9% were found to be completely normal or only to have mild cardiac failure that could be treated medically or moderate macrocephaly without neurological symptoms or mental retardation. In the embolized group 5.8% died as a result of the wrong treatment (1 case) or poor timing of embolization 3 days after ventricular shunting (1 case). The overall mortality (embolized and non-embolized groups) in the neonatal children was 27.7% with a total of 18.6% for all ages. Complete morphological exclusion of the arteriovenous malformation was accomplished in 41.9%; 74.4% of all children referred are now clinically normal or present moderate mental retardation which is diminishing. There was 3% neurological morbidity in the embolized group (only following the venous approach) in 78 sessions and more than 100 arteries embolized. These results compare favorably with surgical or other techniques of arterial embolization (balloon or particles), as well as transvenous (transtorcular or transfemoral) embolization, where the morbidity and mortality are significantly higher and the late clinical evaluation is seldom satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Vein of Galen Aneurysms: Presentation and Endovascular Management

“…Five out of the 6 survivors appeared neurologically intact. Lasjaunias et al [14,15] presented a series of 120 cases that were managed with 191 embolizations (average of 2.4 sessions per patient). Out of the 120 patients, 78 patients were managed by interventional neuroradiology methods.…”

“…Untreated VGAMs have a very poor prognosis [15,16]. Prior to development of neuroendovascular techniques, surgery was the only available therapeutic option.…”

“…Seven out of the 78 died, 3 sustained permanent neurological disabilities, 10 experienced transient neurological symptoms and 47 were found neurologically intact. Out of the 42 untreated children, 12 were lost to follow-up, 21 declined treatment, 14 died, and 12 were lost to follow-up [14,15]. …”

Spontaneous Thrombosis of Vein of Galen Aneurysmal Malformation

“…Initial treatment is aimed at aggressive detection and management of cardiac failure. Patients in cardiac failure or borderline cardiac failure should be treated with prompt arteriography and embolization with reportable success [48]. An asymptomatic infant with the type of AVG described above could be treated expectantly and followed with MRI/MR angiography and serial examinations awaiting spontaneous thrombosis that may be relatively well tolerated and result in a cure of the lesion.…”

Neonatal Superficial Cerebral Arteriovenous Malformations

“…However, the complexity of the arteriovenous shunting, and the vascularity of the overlying meninges, often makes surgical removal difficult, as indicated in the patients in our series. Embolization techniques have been improved for neonates and small children, and several series of infants with vein of Galen type A VM treated by transarterial or transvenous embolization, have been re ported [14,[34][35][36]. While transvenous embolization of the vein of Galen using coils has been helpful in control ling the cardiac failure in some newborns with vein of Galen type A VM [34], this technique is not appropriate for infants with pial A V M , as indicated by patient 2 in our series.…”