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Udine M, Croci D, Wasserman J, A Noureldine MH, Monsour M, Vakharia K, Agazzi S. Vein of Galen Malformations in Adults. Clin Neurol Neurosurg 2023; 228:107671. [PMID: 36996672 DOI: 10.1016/j.clineuro.2023.107671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Vein of Galen Malformations (VoGM) are rare vascular malformations, typically seen in pediatric age groups. Even more rarely, VoGM's may be seen later in adulthood. In this case report and systematic review, we provide a thorough description of the current literature as well as provide a case example exploring the diagnosis, imaging, treatment, and management of VoGM in adults. METHODS In accordance with PRISMA guidelines, we performed a systematic literature search for all relevant cases and case series of VoGM in adult patients. The reference list of all articles were reviewed for additional relevant cases. Articles were included if they described a VoGM of a patient over the age of 18 years old and published in English. 149 articles were originally identified and 26 described cases met our inclusion criteria. RESULTS In our literature review we found 26 patients that met our inclusion criteria. We found 14 male patients and 12 female patients. The mean age at presentation was 37.2 years (median=34 years, SD= 13.6 years). The most common presenting symptoms of patient were headache (n = 9), seizure (n = 6), and vomiting (n = 4). Of the 12 cases which clearly reported the subtype of VoGM, the choroidal type was more frequently seen (n = 10) compared to the mural type (n = 2). In 3 patients, the VoGM was thrombosed at time of diagnosis. Of the 26 patients, endovascular treatment was performed most frequently (n = 8) but some received microsurgical treatment (n = 4) or were treated conservatively (n = 6). Other treatment modalities included (ventriculoperitoneal shunt, ventriculostomy) (n = 5). In 3 cases treatment was not specified. In comparison to VoGM seen in pediatric or neonatal populations, VoGM in adults generally resulted in more favorable outcomes with only 2 patients reported to have passed away following treatment. CONCLUSION VoGM remains a rare finding amongst the adult population. Hence, we described the clinical presentation, treatment modalities, and outcomes of the cases described in the English literature. Perhaps due to the rate of thrombosis and the unique angioarchitecture seen in adult VoGM patients, outcomes were generally more favorable than those described in the literature in pediatric or neonate VoGM patients.
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Affiliation(s)
- Matthew Udine
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Davide Croci
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jacob Wasserman
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Molly Monsour
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.
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Pulido LF, Murcia Salazar D, Gómez Amarillo D, Useche JN, Ghotme KA. Spontaneous thrombosis of a vein of Galen malformation associated with acute sinusitis: a case report. Childs Nerv Syst 2021; 37:3271-3276. [PMID: 33595709 DOI: 10.1007/s00381-021-05072-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
The vein of Galen malformation is caused by an abnormal shunting between choroidal arteries and the median prosencephalic vein during embryological development, leading to increased blood flow to the deep cerebral veins, intracranial damage, and systemic repercussions. Idiopathic spontaneous thrombosis of a vein of Galen malformation is rare, and its association with acute sinusitis has not been reported in the literature. We present the case of a girl with a postnatal diagnosis of a vein of Galen malformation at the age of 16 months, with secondary pulmonary hypertension that was adequately controlled with spironolactone. At 3 years old, while expecting elective endovascular treatment, the patient developed spontaneous thrombosis of the vein of Galen malformation, concomitant to an acute sinusitis episode, with complete resolution of the vascular malformation and secondary pulmonary hypertension. The patient continued with normal neurological development over a 5-year follow-up. We discuss the main pathophysiologic mechanisms that can explain spontaneous thrombosis of VOGMs and the patient's outcome. Awareness of different mechanisms that can lead to spontaneous thrombosis can help in the decision-making process and prompt targeted approaches to individual patients with a vein of Galen malformation.
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Affiliation(s)
- Luis Fernando Pulido
- Faculty of Medicine, Universidad de los Andes, Cra 1 N° 18A - 12, Bogotá, Colombia
| | - Diana Murcia Salazar
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, USA
| | - Diego Gómez Amarillo
- Department of Neurosurgery, Fundación Santafé de Bogotá, Carrera 7 No. 117 - 15, Bogotá, Colombia
| | - Juan Nicolás Useche
- Radiology and Diagnostic Imaging Department, Fundación Santa Fe de Bogotá, Carrera 7 No. 117 - 15, Bogotá, Colombia
| | - Kemel A Ghotme
- Department of Neurosurgery, Fundación Santafé de Bogotá, Carrera 7 No. 117 - 15, Bogotá, Colombia.
- Translational Neuroscience Research Lab, Universidad de La Sabana, Autopista Norte, KM 7, Chía, Colombia, 250001.
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Kumar KK, Fornoff LE, Dodd RL, Marks MP, Hong DS. Spontaneous regression of a vein of Galen aneurysmal malformation in a pediatric patient: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20171. [PMID: 35855311 PMCID: PMC9241347 DOI: 10.3171/case20171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Vein of Galen aneurysmal malformations (VGAMs) are rare congenital intracranial vascular lesions that represent 30% of all pediatric vascular anomalies. These lesions are associated with severe manifestations, including congestive heart failure, hydrocephalus, and spontaneous hemorrhage. The mainstay of management is medical stabilization followed by endovascular embolization of the lesion. Although VGAM was first reported in 1937, there are few published cases demonstrating spontaneous regression of the lesion. OBSERVATIONS The authors report the case of a 31-month-old female who presented with an incidentally found VGAM. After initial evaluation, including magnetic resonance imaging and angiography, the patient was lost to follow-up. Upon her return to the clinic at age 12 years, the previously identified VGAM was absent, indicative of involution of the lesion. The patient remained asymptomatic and met appropriate developmental milestones during this interval. LESSONS This report adds a rare case of the spontaneous resolution of VGAM to the literature. This case may suggest the presence of VGAMs that are asymptomatic, undetected, and regress within the pediatric population. Future studies may benefit from identifying imaging and angiographic findings predictive of spontaneous regression. There may be a role for conservative management in particular cases of asymptomatic and medically stable children with VGAMs.
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Yan J, Gopaul R, Wen J, Li XS, Tang JF. The natural progression of VGAMs and the need for urgent medical attention: a systematic review and meta-analysis. J Neurointerv Surg 2016; 9:564-570. [PMID: 27091749 DOI: 10.1136/neurintsurg-2015-012212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/20/2016] [Accepted: 03/25/2016] [Indexed: 11/04/2022]
Abstract
BackgroundVein of Galen aneurysmal malformations (VGAMs) are congenital disorders that may require emergency treatment and some may cause sudden death before medical attention is provided. Some patients also have a spontaneous thrombosis.ObjectiveTo understand the natural progression of VGAMs through a systematic literature review.MethodsWe examined PubMed to identify studies published between July 1973 and March 2015. We determined the proportion of patients with VGAM who died before receiving medical attention, who received emergency treatment, or had a spontaneous thrombosis. We pooled estimates of proportions with corresponding 95% CIs calculated using the raw (ie, untransformed) proportions.ResultsThe 31 studies obtained described the outcome of 754 patients with VGAM. The probability of sudden death risk was 4% (95% CI 1% to 7%; I2=51.6%); of an emergency operation was 46% (95% CI 34% to 58%; I2=93.2%); and of spontaneous thromboses 1% (95% CI 0% to 2%; I2=0%) of cases. Differences between age and clinical outcomes of patients with spontaneous thromboses were significant according to the rank test (Mann–Whitney U test, Z=−2.398, p=0.016), both having a linear correlation (χ2 test, p=0.022).ConclusionsOver time, the rate of preoperative sudden death in patients with VGAM gradually declined and the rate of emergency operations gradually increased. The outcome of patients with early spontaneous thromboses was good. Our study provides a definitive description of the natural progression of VGAMs and the need for urgent medical attention.
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Affiliation(s)
- Jun Yan
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Guilin Medical University, Guilin City, Guangxi Zhuang Autonomous Region, China
| | - Roodrajeetsing Gopaul
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jing Wen
- Department of Rheumatism, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xi-Sheng Li
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jing-Feng Tang
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Guilin Medical University, Guilin City, Guangxi Zhuang Autonomous Region, China
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Mahmoodi R, Habibi Z, Heidari V, Nejat F. Spontaneous regression and complete disappearance of the vein of Galen aneurysmal malformation. Childs Nerv Syst 2016; 32:593-8. [PMID: 26869053 DOI: 10.1007/s00381-016-3033-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Thrombosis is frequently observed in Galen malformation, but propagation of thrombosis resulting in the disappearance of the aneurysmal malformation is a very rare clinical condition. CASE REPORT A rare case of spontaneous regression and disappearance of the vein of Galen aneurysmal malformation (VoGAM) in a pediatric patient with repeated generalized seizure, increased head circumference, and congestive heart failure is recorded. The course of regression from infancy to 8 years of age has been depicted. Radiological studies initially demonstrated VoGAM complicated by an intra-cerebral hemorrhage and hydrocephalus, which later underwent spontaneous regression. Long-term clinical and radiological follow-up is presented. DISCUSSION Different conditions including hemodynamic alteration, compression of adjacent hematoma, and narrowing of related vascular structures have been described to cause thrombosis of VoGAM. The relevant literature to address possible mechanism is reviewed.
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Affiliation(s)
- Ramin Mahmoodi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Zohreh Habibi
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Vahid Heidari
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Farideh Nejat
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran.
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Abstract
Vein of Galen malformation (VOGM) is a rare congenital vascular anomaly, comprising about 1% of all intracranial vascular anomalies, predominantly affecting the children less than 1 year of age. A 6-month-old infant presented with complaints of increasing head size of 3 months duration and multiple episodes of vomiting associated with refusal to feed since 7 days. He was a known case of VOGM who had initially refused treatment. Investigations revealed a spontaneously thrombosed VOGM with obstructive hydrocephalous. Child improved uneventfully with ventriculoperitoneal shunt. Spontaneous thrombosis of a VOGM is a rare occurrence and carries a better prognosis. The relevant literature is discussed with emphasis on etiopathogenesis, mechanism, and management of spontaneous thrombosis of the malformation.
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Affiliation(s)
- Chandan B Mohanty
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, India
| | - Somanna Sampath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, India
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Varying clinical and imaging outcomes in patients with spontaneous thrombosis of vein of Galen malformation--a report of two cases. Childs Nerv Syst 2015; 31:809-13. [PMID: 25566822 DOI: 10.1007/s00381-014-2612-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vein of Galen malformations are rare congenital intracranial vascular malformations. The pathophysiological consequences usually manifest as high-output cardiac failure and neurological symptoms secondary to cerebral venous congestion and abnormal CSF flow. Management of these patients is complex. Indications and time to intervene are decided depending upon the age of child, clinical presentation, and multisystemic neonatal scores. Many of these children presenting early and who are not in cardiac failure are expectantly followed up. Spontaneous thrombosis of the vein of Galen malformation is a rare occurrence in these as such rare vascular malformations. METHODS This review reports two cases of spontaneous thrombosis of the vein of Galen malformations with varying clinical as well as imaging outcomes. Possible pathophysiologic mechanisms are discussed with review of literature. RESULTS This report highlights the importance of vigilant clinical and imaging follow-up even after spontaneous thrombosis in the vein of Galen malformations.
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