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Jerele C, Lovrič D, Kuhelj D. Pediatric Interventional Neuroradiology: Opportunities and Challenges. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040715. [PMID: 37189964 DOI: 10.3390/children10040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
Pediatric interventional neuroradiology (PINR) is a relatively new field of diagnostic and therapeutic care in the pediatric population that has seen considerable advances in recent decades. However, it is still lagging behind adult interventional neuroradiology due to a variety of reasons, including the lack of evidence validating pediatric-specific procedures, the relative absence of pediatric-specific equipment, and the challenges in establishing and maintaining PINR competencies in a relatively small number of cases. Despite these challenges, the number and variety of PINR procedures are expanding for a variety of indications, including unique pediatric conditions, and are associated with reduced morbidity and psychological stigma. Continued technological advances, such as improved catheter and microwire designs and novel embolic agents, are also contributing to the growth of the field. This review aims to increase awareness of PINR and provide an overview of the current evidence base for minimally invasive neurological interventions in children. Important considerations, such as sedation, contrast agent use, and radiation protection, will also be discussed, taking into account the distinct characteristics of the pediatric population. The review highlights the usefulness and benefits of PINR and emphasizes the need for ongoing research and development to further advance this field.
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Affiliation(s)
- Cene Jerele
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1104 Ljubljana, Slovenia
| | - Dimitrij Lovrič
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1104 Ljubljana, Slovenia
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2
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D'Amico A, Tinari S, D'Antonio F, Rizzo G, Liberati M, Vasciaveo L, Buca D. Outcome of fetal Vein Galen aneurysmal malformations: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022; 35:5312-5317. [PMID: 33508985 DOI: 10.1080/14767058.2021.1878494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To report the outcome of fetuses with a prenatal diagnosis of Vein of Galen (VOG) malformation. METHODS PubMed and Embase databases were searched. Random effect meta-analysis of proportions was used to analyze the data. The outcomes explored were prenatal ultrasound findings, mortality, preterm birth (PTB), abnormal neurological outcome, associated findings detected at post-natal brain imaging, need for anticonvulsant therapy, and the rate of children free from neurological impairment. Random effect meta-analysis of proportions were used to analyze the data. RESULTS Eleven studies (226 fetuses with a prenatal diagnosis of VOG malformation) were included. All cases were detected during the third trimester of pregnancy. Ventriculomegaly was detected in 31.8% (95% CI 27.6-47.7), cardiomegaly or other ultrasound signs of cardiac compromise in 23.1% (95% CI 14.9-32.5) and hydrops in 7.3% (95% CI 2.8-13.6) of cases. The incidence of IUD, NND, and PND was 1.5% (95% CI 0.2-4.3), 23.8% (95% CI 16.9-31.4), and 24.5% (95% CI 17.6-32.2), respectively, while 12.6% (95% CI 6.0-21.2) of pregnancies were complicated by PTB. Abnormal neurodevelopmental outcome was observed in 36.7% (95% CI 27.9-39.7) of cases, while 60.5% (95% CI 17.0-82.0) of children had abnormal findings on post-natal imaging and only 29.7% (95% CI 23.3-36.5) were free from neurological impairment after birth, although there was a wide heterogeneity in the time at follow-up between the included studies. CONCLUSION VOG malformation diagnoses during fetal life is associated with a high incidence of brain damage, cardiac compromise, and abnormal neurodevelopmental outcome after birth.
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Affiliation(s)
- Alice D'Amico
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - Sara Tinari
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Roma, Italy
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Marco Liberati
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - Lorenzo Vasciaveo
- Department of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
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Choque-Velasquez J, Colasanti R, Muhammad S, Chioffi F, Hernesniemi J. Vascular Lesions of the Pineal Region: A Comprehensive Review of the Therapeutic Options. World Neurosurg 2022; 159:298-313. [PMID: 35255631 DOI: 10.1016/j.wneu.2021.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vascular lesions of the pineal region comprise aneurysms of the pineal region, arteriovenous malformations, cavernous malformations, and vein of Galen malformations. In the present report, we have offered an extensive review of each vascular pineal region lesion. METHODS We performed an extensive literature review, focusing on the current therapeutic options available for the different vascular lesions of the pineal region. RESULTS Vascular lesions of the pineal region are rare. Microneurosurgery remains a valid treatment of cavernomas, arteriovenous malformations, and aneurysms. Endovascular treatments seem to be the first option for the vein of Galen malformations, followed by microneurosurgery. Radiosurgery seems beneficial for small-size arteriovenous malformations. Complex and large vascular lesions will require a combination of multiple treatments. CONCLUSIONS Vascular lesions of the pineal region are complex, uncommon diseases. Thus, definitive therapeutic modalities for these lesions require further research.
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Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Sajjad Muhammad
- Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Franco Chioffi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Juha Hernesniemi
- Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
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Tas B, Starnoni D, Smajda S, Vivanti AJ, Adamsbaum C, Eyries M, Melki J, Tawk M, Ozanne A, Revencu N, Soubrier F, Siala S, Vikkula M, Deiva K, Saliou G. Arteriovenous Cerebral High Flow Shunts in Children: From Genotype to Phenotype. Front Pediatr 2022; 10:871565. [PMID: 35547535 PMCID: PMC9081809 DOI: 10.3389/fped.2022.871565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To study the genotypes and phenotypes of cerebral arteriovenous fistulas that drain or do not drain through the vein of Galen, and true vein of Galen aneurysmal malformations, in order to determine whether genotyping could help improve classification of these malformations and their management. METHODS We carried out a retrospective review of genetic and phenotypic data in databases of four centers. All children with cerebral arteriovenous fistula or vein of Galen aneurysmal malformations aged below 18 years at onset were included. We recorded the nature of the genetic variant or absence of variant, age at onset, type of malformation, symptoms at onset (hemorrhage, neurological deficit, hydrocephalus, incidental, and heart failure), type of venous drainage and the long-term outcome. RESULTS One hundred and fifteen children were included. Autosomal dominant variants were identified in 39% of patients. The most frequent variant affected was the RASA1 gene (25%) followed by EPHB4 (8%) and the HHT-associated genes (5%). HHT gene variants were only observed in pial arteriovenous fistula not draining into the vein of Galen; on the contrary, EPHB4 variants were only seen in genuine vein of Galen aneurysmal malformation. RASA1 variants were identified in all types of shunts. CONCLUSIONS EPHB4 variants seem specific to the vein of Galen aneurysmal malformation, RASA1 variants are associated with either pial arteriovenous fistulas or with genuine VGAM and HHT gene variants seem specific to pial arteriovenous fistulas. The genetic data helps to classify these malformations and to guide treatment toward lowest risk of post-operative cerebral ischemic-hemorrhagic complications.
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Affiliation(s)
- Berivan Tas
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Daniele Starnoni
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Stanislas Smajda
- de Duve Institute, Université Catholique de Louvain, Human Molecular Genetics, Brussels, Belgium
| | - Alexandre J Vivanti
- INSERM U1195 Petites Molécules de Neuroprotection, Neurogénération et Remyélinisation, Le Kremlin Bicêtre, France
| | - Catherine Adamsbaum
- Service de Radiologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Laboratoire Traitement et Communication de l'Information, TELECOM ParisTech, Paris, France
| | - Mélanie Eyries
- Department of Genetics, Hôpital Pitié-Salpêtrière, Paris, France
| | - Judith Melki
- INSERM U1195 Petites Molécules de Neuroprotection, Neurogénération et Remyélinisation, Le Kremlin Bicêtre, France
| | - Marcel Tawk
- INSERM U1195 Petites Molécules de Neuroprotection, Neurogénération et Remyélinisation, Le Kremlin Bicêtre, France
| | - Augustin Ozanne
- Department of Neuroradiology, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Nicole Revencu
- de Duve Institute, Université Catholique de Louvain, Human Molecular Genetics, Brussels, Belgium
| | - Florent Soubrier
- Department of Genetics, Hôpital Pitié-Salpêtrière, Paris, France
| | - Selima Siala
- Service de Radiologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Miikka Vikkula
- de Duve Institute, Université Catholique de Louvain, Human Molecular Genetics, Brussels, Belgium
| | - Kumaran Deiva
- Service de Neuropédiatrie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Guillaume Saliou
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
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5
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Ramdani H, Sahri IE, Elharras Y, Haddad SE, Allali N, Chat L. Vein of Galen aneurysmal malformation presenting as severe heart failure in a neonate. Radiol Case Rep 2021; 16:3961-3964. [PMID: 34745403 PMCID: PMC8551785 DOI: 10.1016/j.radcr.2021.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/21/2022] Open
Abstract
The vein of Galen aneurysmal malformation (VGAM) is a rare cerebral arteriovenous malformation that can be life-threatening if not diagnosed and treated early. VGAM usually presents in the neonatal period with high-output cardiac failure. We report the case of a full-term male neonate who presented with respiratory distress, and a fontanel bruit soon after birth. A chest radiograph revealed marked cardiomegaly. Transthoracic echocardiography showed dilatation of all four cardiac chambers and a patent ductus arteriosus. Transfontanellar doppler ultrasound and brain computed tomography confirmed the diagnosis of a VGAM. Clinical worsening took place despite aggressive hemodynamic and ventilatory support. The patient's Bicêtre Neonatal Evaluation Score for embolization was 2. Endovascular treatment could not be performed. The patient regretfully passed away. VGAM should be considered in the differential diagnosis of neonatal congestive heart failure with a structurally normal heart. Early diagnosis and treatment improve prognosis considerably.
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Affiliation(s)
- Hanae Ramdani
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
- Corresponding author.
| | - Imad-eddine Sahri
- Neurosurgery department - Mohammed Vth military hospital-Rabat, Ryad street-10010 Rabat, MOROCCO
| | - Yahya Elharras
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
| | - Siham El Haddad
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
| | - Nazik Allali
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
| | - Latifa Chat
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
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White TG, Dehdashti AR, Woo HH. Scepter mini assisted angiographic cure of a Vein of Galen Malformation with n-butyl cyanoacrylate. Interv Neuroradiol 2021; 27:663-666. [PMID: 33611967 PMCID: PMC8493341 DOI: 10.1177/1591019921993368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/24/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Even in the modern endovascular era, the treatment of Vein of Galen Malformations (VOGM) is extremely challenging. While their natural history is very poor, endovascular embolization has emerged as the standard of care. These lesions often require multiple treatment sessions to decrease shunting, with each treatment including multiple pedicles. Here we present the first reported use of the Scepter Mini (Microvention, Aliso Viejo, CA) in the treatment of vein of Galen malformations. CLINICAL PRESENTATION A 7 month old female presented with an enlarging VOGM that was initially identified on prenatal ultrasound. Given the enlarging size of the lesion and failure to meet developmental milestones, the patient underwent planned endovascular embolization of the VOGM. The novel Scepter Mini balloon catheter was used for treatment of this lesion affording easy access to the target pedicle and immediate flow arrest which allowed for immediate cure of the lesion. CONCLUSION The novel Scepter Mini Balloon (Microvention, Aliso Viejo, CA) afforded excellent distal access with subsequent immediate flow arrest therefore facilitating endovascular cure. Initially, a staged approach was favored for the treatment of the lesion, but the flow arrest achieved by the Scepter mini facilitated immediate occlusion from a single pedicle.
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Affiliation(s)
- Timothy G White
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, USA
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7
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Primikiris P, Hadjigeorgiou G, Tsamopoulou M, Biondi A, Iosif C. Review on the current treatment status of vein of Galen malformations and future directions in research and treatment. Expert Rev Med Devices 2021; 18:933-954. [PMID: 34424109 DOI: 10.1080/17434440.2021.1970527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Vein of Galen malformations (VOGMs) represent a rare pathologic entity with often catastrophic natural history. The advances in endovascular treatment in recent years have allowed for a paradigm shift in the treatment and outcome of these high-flow shunts, even though their pathogenetic mechanisms and evolution remain in part obscure. AREAS COVERED The overall management of VOGMs requires a tailored case-to-case approach, starting with in utero detection and reserving endovascular treatment for indicated cases. Lately, the advances in translational research with whole-genome sequencing and the coupling with cellular-level hemodynamics attempt to shed more light in the pathogenesis and evolution of these lesions. At the same time the advances in endovascular techniques allow for more safety and tailored technical strategy planning. Furthermore, the advances in MRI techniques allow a better understanding of their vascular anatomy. In view of these recent advances and by performing a PUBMED literature review of the last 15 years, we attempt a review of the evolutions in the imaging, management, endovascular treatment and understanding of underlying mechanisms for VOGMs. EXPERT OPINION The progress in the fields detailed in this review appears very promising in better understanding VOGMs and expanding the available therapeutic arsenal.
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Affiliation(s)
- Panagiotis Primikiris
- Department of Interventional Neuroradiology, Jean Minjoz University Hospital, Besancon, France
| | | | - Maria Tsamopoulou
- School of Medicine, National Kapodistrian University of Athens, Greece
| | - Alessandra Biondi
- Department of Interventional Neuroradiology, Jean Minjoz University Hospital, Besancon, France
| | - Christina Iosif
- School of Medicine, European University of Cyprus, Nicosia, Cyprus.,Department of Interventional Neuroradiology, Henry Dunant Hospital, Athens, Greece
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8
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Bertino F, Trofimova AV, Gilyard SN, Hawkins CM. Vascular anomalies of the head and neck: diagnosis and treatment. Pediatr Radiol 2021; 51:1162-1184. [PMID: 33860862 DOI: 10.1007/s00247-021-04968-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/27/2020] [Accepted: 01/07/2021] [Indexed: 01/19/2023]
Abstract
Vascular malformations and vascular tumors comprise the two specific subsets of vascular anomalies that arise as a result of disorganized angiogenesis and neoplasm, respectively. Malformations are separate entities from vascular tumors (e.g., hemangiomas) and are recognized by the International Society for the Study of Vascular Anomalies (ISSVA) as such. Vascular malformations are classified into four main groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors are neoplastic growths of blood vessels and are morphologically and molecularly distinct from malformations but can arise in the head and neck and have syndromic association. Head and neck vascular anomalies are not uncommon in the pediatric population and require special care in the workup, diagnostic imaging and clinical care. The purpose of this manuscript is to discuss the diagnosis and management of the most common intracranial and extracranial vascular malformations and tumors in the head and neck in children and adolescents.
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Affiliation(s)
- Frederic Bertino
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.
| | - Anna V Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - Shenise N Gilyard
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.,Division of Pediatric Radiology, Division of Interventional Radiology and Image Guided Medicine, Children's Healthcare of Atlanta, Emory + Children's Pediatric Institute, Atlanta, GA, USA
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9
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Bhatia K, Mendes Pereira V, Krings T, Ter Brugge K, Kortman H, Dirks P, Armstrong D, Shroff M, Muthusami P. Factors Contributing to Major Neurological Complications From Vein of Galen Malformation Embolization. JAMA Neurol 2021; 77:992-999. [PMID: 32338714 DOI: 10.1001/jamaneurol.2020.0825] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Major 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 Participants This 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 Measures The 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. Results Of 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 Relevance In 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.
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Affiliation(s)
- Kartik Bhatia
- Department of Medical Imaging, Sydney Children's Hospital Network, Westmead, Australia.,Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Karel Ter Brugge
- Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Hans Kortman
- Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Peter Dirks
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek Armstrong
- Image-Guided Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Image-Guided Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Image-Guided Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
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10
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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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11
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Nesbit GM. Neurovascular disease and syndromes: Diagnosis and therapy in children. HANDBOOK OF CLINICAL NEUROLOGY 2020; 176:305-323. [PMID: 33272401 DOI: 10.1016/b978-0-444-64034-5.00015-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pediatric neurovascular disease runs the chronologic spectrum with dramatic changes in the presentation, evaluation, and treatment from the prenatal, perinatal, and infant periods through childhood and adolescence. These diseases are often dynamic throughout this period and the dynamic continues throughout life. There are four major categories: high-flow arteriovenous shunting lesions, arterial aneurysms, low-flow vascular lesions, and vascular occlusive disease. The high-flow lesions can be subdivided into a vein of Galen malformation, non-Galenic arteriovenous fistula, dural sinus malformations and fistula, and arteriovenous malformation. Low-flow vascular lesions include cerebral cavernous malformation, developmental venous anomaly, and capillary telangiectasia. The cerebrovascular occlusive disease can be divided between arterial occlusive disease and cerebral venous sinus thrombosis. The presentation of each of these entities can be very similar, especially in younger children; however, imaging and laboratory analysis can establish the diagnosis leading to the most appropriate therapy. A multidisciplinary team, dedicated to treating pediatric cerebrovascular disease, is important in delivering the best outcomes in these complex diseases. Given the relative rarity of pediatric presentation of cerebrovascular disease, many apply adult concepts to children. A better understanding of the diseases and their difference from adults makes a critical difference in selecting the correct approach.
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Affiliation(s)
- Gary M Nesbit
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, United States.
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12
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Bouchghoul H, Adamsbaum C, Maurey H, Ozanne A, Senat MV. Pseudofeeders: sonographic sign of poor prognosis in fetus with vein of Galen malformation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:296-297. [PMID: 32449243 DOI: 10.1002/uog.22097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- H Bouchghoul
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
| | - C Adamsbaum
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
- Department of Pediatric Radiology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - H Maurey
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
- Department of Neuropediatrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - A Ozanne
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
- Department of Interventional Neuroradiology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - M V Senat
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
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Taffin H, Maurey H, Ozanne A, Durand P, Husson B, Knebel JF, Adamsbaum C, Deiva K, Saliou G. Long-term outcome of vein of Galen malformation. Dev Med Child Neurol 2020; 62:729-734. [PMID: 31713850 DOI: 10.1111/dmcn.14392] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 11/26/2022]
Abstract
AIM To describe the long-term outcomes of children by the time they reached school age with vein of Galen aneurysmal malformation (VGAM). METHOD This was a retrospective observational study on a consecutive cohort of patients with VGAM. We included patients with at least one Francophone parent, aged between 6 and 11 years at the time of long-term evaluation. The neurological outcome was assessed with the King's Outcome Scale for Childhood Injury score and eight neurological and behavioural items from the Rivermead Postconcussion Symptoms questionnaire. RESULTS All 52 patients (17 females, 32 males [data missing for n=3]) with at least one Francophone parent (5 fetuses and 47 children) were included. At the long-term evaluation time-point, 33 patients were alive and 19 patients had died. Risk of postnatal death was associated with severe neonatal cardiac failure (p=0.007) or isosystemic or suprasystemic pulmonary hypertension (p=0.014). Among survivors, 19 had a good outcome with normal schooling and 14 had a poor outcome. Moreover, among the good outcome patients, a large proportion had neurodevelopmental alterations. INTERPRETATION Long-term outcome of patients with VGAM appears to be less favourable than outcome described at the short- and medium-term, even in the absence of encephalomalacia at birth. Even patients with good outcome often have neuropsychological disorders that may have repercussions on learning and requiring appropriate rehabilitation or medical management. WHAT THIS PAPER ADDS Long-term outcome appears to be less favourable than described at short- and medium-term follow-up. Even patients with good outcome at these time-points often have minor neuropsychological disorders.
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Affiliation(s)
- Hélène Taffin
- Neurologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Hélène Maurey
- Neurologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Augustin Ozanne
- Neuroradiologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Philippe Durand
- Réanimation Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Béatrice Husson
- Radiologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Jean-François Knebel
- Radiodiagnostic et Radiologie Interventionnelle, Centre Hospitalier et Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Catherine Adamsbaum
- Radiologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,LTCI, CNRS, Télécom ParisTech, Université Paris-Saclay, Paris, France
| | - Kumaran Deiva
- Neurologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Guillaume Saliou
- Neuroradiologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Radiodiagnostic et Radiologie Interventionnelle, Centre Hospitalier et Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Faculté de Biologie et de Médecine, UNIL, Lausanne, Switzerland
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Giorgi L, Durand P, Morin L, Miatello J, Merchaoui Z, Lambert V, Boithias C, Senat MV, Stos B, Maurey H, Adamsbaum C, Tissières P, Saliou G, Spelle L, Ozanne A. Management and Outcomes of Neonatal Arteriovenous Brain Malformations with Cardiac Failure: A 17 Years' Experience in a Tertiary Referral Center. J Pediatr 2020; 218:85-91.e2. [PMID: 31870606 DOI: 10.1016/j.jpeds.2019.10.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the management and outcomes of neonatal arteriovenous brain malformations (mostly vein of Galen malformations) complicated by cardiac failure in the era of prenatal diagnosis and endovascular treatment in a tertiary referral center. STUDY DESIGN This observational study included 77 living newborn infants with arteriovenous brain malformations with cardiac failure, admitted to our referral center from 2001 to 2017. All infants underwent cardiovascular evaluation including echocardiogram and brain magnetic resonance imaging. Long-term survivors had standard neurocognitive assessments. RESULTS Infants were admitted to the neonatal intensive care unit at a median of 5 days of age (including 18 inborn patients since 2009). Sixty transarterial shunt embolizations were performed in 46 patients during their first month (at a median age of 7.5 days) or postponed beyond the first month in another 10 long-term survivors. Embolization was not performed in 21 infants, including 19 nonsurvivors with severe brain injury, uncontrolled cardiac failure, or multiple organ failure. Cardiac failure requiring vasopressor infusion occurred in 48 patients (64%) during the hospitalization. Infants who survived the first month underwent a median of 3 embolization sessions. Among the 51 survivors, 21 had a good outcome and 19 had a poor outcome at follow-up (median age, 5.3 years); 11 children were lost to follow-up. CONCLUSIONS In the era of multidisciplinary prenatal diagnosis, using a standardized care protocol, 47% of liveborn infants with an arteriovenous shunt malformation with cardiac failure experienced a favorable outcome.
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Affiliation(s)
- Laetitia Giorgi
- Division of Pediatrics and Neonatal Intensive Care, Paris-Saclay University Hopsitals, Bicêtre Medical center Assistance publique-hôpitaux de Paris, France; Department of Pediatrics Neurology, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance Publique Hôpitaux de Paris, France
| | - Phillippe Durand
- Division of Pediatrics and Neonatal Intensive Care, Paris-Saclay University Hopsitals, Bicêtre Medical center Assistance publique-hôpitaux de Paris, France.
| | - Luc Morin
- Division of Pediatrics and Neonatal Intensive Care, Paris-Saclay University Hopsitals, Bicêtre Medical center Assistance publique-hôpitaux de Paris, France
| | - Jordi Miatello
- Division of Pediatrics and Neonatal Intensive Care, Paris-Saclay University Hopsitals, Bicêtre Medical center Assistance publique-hôpitaux de Paris, France
| | - Zied Merchaoui
- Division of Pediatrics and Neonatal Intensive Care, Paris-Saclay University Hopsitals, Bicêtre Medical center Assistance publique-hôpitaux de Paris, France
| | - Virginie Lambert
- Department of Obstetrics and Gynecology, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France
| | - Claire Boithias
- Department of Obstetrics and Gynecology, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France
| | - Marie Victoire Senat
- Department of Obstetrics and Gynecology, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France
| | - Bertrand Stos
- Department of Obstetrics and Gynecology, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France
| | - Hélène Maurey
- Department of Pediatrics Neurology, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance Publique Hôpitaux de Paris, France
| | - Catherine Adamsbaum
- Department of Pediatrics Radiology, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France
| | - Pierre Tissières
- Division of Pediatrics and Neonatal Intensive Care, Paris-Saclay University Hopsitals, Bicêtre Medical center Assistance publique-hôpitaux de Paris, France
| | - Guillaume Saliou
- Department of Interventional Neuroradiology Neuro Brain vascular center, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France; Department of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital, CHUV-UNIL, Lausanne, Switzerland
| | - Laurent Spelle
- Department of Interventional Neuroradiology Neuro Brain vascular center, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology Neuro Brain vascular center, Paris-Saclay University Hospitals, Bicêtre medical center, Assistance publique-hôpitaux de Paris, France
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15
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Lv X, Jiang C, Wang J. Pediatric intracranial arteriovenous shunts: Advances in diagnosis and treatment. Eur J Paediatr Neurol 2020; 25:29-39. [PMID: 31996298 DOI: 10.1016/j.ejpn.2019.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/24/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
Pediatric intracranial arteriovenous shunts (IAVSs) comprise a wide range of lesions, including pial arteriovenous malformation (AVM) and arteriovenous fistula (AVF), dural arteriovenous fistula (DAVF) and vein of Galen aneurysmal malformation (VGAM). We provide an overview of pediatric IAVSs, encompassing both diagnosis and endovascular treatment. We include references from pertinent literature and representative cases from our hospital. Pediatric IAVS are frequently associated two broader conditions, such as capillary malformation-arteriovenous malformation (CM-AVM) and hereditary hemorrhagic telangiectasia (HHT). These conditions and the associated genetic mutations have only recently been described. Their impact on the brain will be different in the prenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group and the current strategies of endovascular treatment in the management of these vascular lesions will be discussed. This review could improve the understanding of pediatric IAVSs and their diagnosis and treatment.
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Affiliation(s)
- Xianli Lv
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Chuhan Jiang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Malarbi S, Gunn-Charlton JK, Burnett AC, Prentice TM, Williams A, Mitchell P, Wray A, Hunt RW. Outcome of vein of Galen malformation presenting in the neonatal period. Arch Dis Child 2019; 104:1064-1069. [PMID: 31122925 DOI: 10.1136/archdischild-2018-316495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Vein of Galenaneurysmal malformation (VGAM) is a rare but important congenital malformation presenting to neonatal intensive care units (NICUs), and with a change from surgical to endovascular management, survival for this condition has improved. However, there is little reported about the medical management decisions of infants with this condition and the associated long-term neurodevelopmental outcomes. We aim to report a single centre experience of both acute treatment and long-term outcomes of VGAM for those infants admitted to our NICU soon after birth. DESIGN Retrospective cohort study over a 15-year period from 2001 to 2015 inclusive. SETTING A quaternary NICU at The Royal Children's Hospital, Melbourne, Australia. PARTICIPANTS 24 newborn infants referred for management of VGAM. There were no eligibility criteria set for this study; all presenting infants were included. INTERVENTIONS None. MAIN OUTCOMES MEASURES Clinical neuroimaging data were gathered. Surviving children were formally assessed with a battery of tests administered by a neuropsychologist and occupational therapist/physiotherapist at various ages across early to middle childhood. RESULTS Fifteen neonates with VGAM did not survive beyond their NICU admission. 10 of these were not offered endovascular intervention. Of the nine surviving infants, only one had a normal neurodevelopmental outcome. CONCLUSIONS The mortality of VGAM presenting in the neonatal period was high, and rates of normal neurodevelopmental outcome for survivors were low. These findings contribute to our understanding of which neonates should be treated and highlights the importance of providing clinical neurodevelopmental follow-up to survivors beyond their infant years.
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Affiliation(s)
- Stephanie Malarbi
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Julia K Gunn-Charlton
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Alice C Burnett
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Trisha M Prentice
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Amy Williams
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Peter Mitchell
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Alison Wray
- Department of Neurosurgery, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Rod W Hunt
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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17
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Choque-Velasquez J, Resendiz-Nieves J, Colasanti R, Collan J, Hernesniemi J. Microsurgical Management of Vascular Malformations of the Pineal Region. World Neurosurg 2018; 117:e669-e678. [DOI: 10.1016/j.wneu.2018.06.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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18
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Gopalan V, Rennie A, Robertson F, Kanagarajah L, Toolis C, Bhate S, Ganesan V. Presentation, course, and outcome of postneonatal presentations of vein of Galen malformation: a large, single-institution case series. Dev Med Child Neurol 2018; 60:424-429. [PMID: 29359331 DOI: 10.1111/dmcn.13676] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 11/30/2022]
Abstract
AIM To describe presentation, clinical course, and outcome in postneonatal presentations of vein of Galen malformation (VGM). METHOD Children older than 28 days presenting with VGM (from 2006-2016) were included. Notes/scans were reviewed. Outcome was dichotomized into 'good' or 'poor' using the Recovery and Recurrence Questionnaire. Logistic regression was performed to explore relationships between clinico-radiological features and outcome. RESULTS Thirty-one children (18 males, 13 females) were included, presenting at a median age of 9.6 months (range 1.2mo-11y 7mo), most commonly with macrocrania (n=24) and prominent facial veins (n=9). Seven had evidence of cardiac failure. VGM morphology was choroidal in 19. Hydrocephalus (n=24) and loss of white matter volume (n=15) were the most common imaging abnormalities. Twenty-nine patients underwent glue embolization (median two per child). Angiographic shunt closure was achieved in 21 out of 28 survivors. Three children died of intracranial haemorrhage (1y, 6y, and 30d after embolization). Ten patients underwent neurosurgical procedures; to treat haemorrhage in four, and hydrocephalus in the rest. Outcome was categorized as good in 20 out of 28 survivors, but this was not predictable on the basis of the variables listed above. INTERPRETATION Postneonatally presenting VGM has distinctive clinico-radiological features, attributable to venous hypertension. Endovascular treatment is associated with good outcomes, but more specific prognostic prediction was not possible within this cohort. WHAT THIS PAPER ADDS Clinical and radiological features in older children with vein of Galen malformation relate to venous hypertension. Outcome is good in most cases with endovascular therapy. Mortality is low but is related to intracranial haemorrhage.
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Affiliation(s)
- Vignesh Gopalan
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Adam Rennie
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Fergus Robertson
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Lakshmi Kanagarajah
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Claire Toolis
- Neurology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sanjay Bhate
- Neurology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Vijeya Ganesan
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK.,Neurology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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19
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20
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Brinjikji W, Krings T, Murad MH, Rouchaud A, Meila D. Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:2308-2314. [PMID: 28982789 DOI: 10.3174/ajnr.a5403] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes after endovascular embolization of vein of Galen malformations remain relatively poorly described. PURPOSE We performed a systematic review of the literature to determine outcomes and predictors of good outcomes following endovascular treatment of vein of Galen malformations. DATA SOURCES We used Ovid MEDLINE, Ovid Embase, and the Web of Science. STUDY SELECTION Our study consisted of all case series with ≥4 patients receiving endovascular treatment of vein of Galen malformations published through January 2017. DATA ANALYSIS We studied the following outcomes: complete/near-complete occlusion rates, technical complications, perioperative stroke, perioperative hemorrhage, technical mortality, all-cause mortality, poor neurologic outcomes, and good neurologic outcomes. Outcomes were stratified by age-group (neonate, infant, child). A random-effects meta-analysis was performed. DATA SYNTHESIS A total of 27 series with 578 patients were included; 41.9% of patients were neonates, 45.0% of patients were infants, and 13.1% of patients were children. All-cause mortality was 14.0% (95% CI, 8.0%-22.0%). Overall good neurologic outcome rates were 62.0% (95% CI, 57.0%-67.0%). Overall poor neurologic outcome rates were 21.0% (95% CI, 17.0%-26.0%). Neonates were significantly less likely to have good neurologic outcomes than infants (48.0%; 95% CI, 35.0%-62.0% versus 77.0%; 95% CI, 70.0%-84.0%; P < .01). Treatment indications following the Bicêtre neonatal evaluation score resulted in significantly higher rates of good neurologic outcome (P = .04). Patients with congestive heart failure had significantly lower rates of good neurologic outcome (OR, 0.50; 95% CI, 0.28-0.88; P = .01). LIMITATIONS Limitations were selection and publication biases. CONCLUSIONS Patients receiving endovascular embolization of vein of Galen malformations experienced good long-term clinical outcomes in >60% of cases. Appropriate patient selection is key as treatment guided by the Bicêtre neonatal evaluation score was associated with improved neurologic outcomes.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B.)
- Neurosurgery, (W.B.)
- Division of Neuroradiology and Neurosurgery (W.B., T.K.), University of Toronto, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - T Krings
- Division of Neuroradiology and Neurosurgery (W.B., T.K.), University of Toronto, Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - M H Murad
- Center for the Science of Healthcare Delivery (M.H.M.), Mayo Clinic, Rochester, Minnesota
| | - A Rouchaud
- Neuroradiology Service (A.R.), Centre Hospitalier Universitaire Bicêtre, Le Kremlin Bicêtre, France
| | - D Meila
- Department of Radiology and Neuroradiology (D.M.), Klinikum Duisburg, Duisburg, Germany
- Department of Diagnostic and Interventional Neuroradiology (D.M.), Medical School Hannover, Hannover, Germany
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21
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George Zaki Ghali M. Galenic pial arteriovenous fistulas: Angioarchitecture, clinical presentation, and therapeutic considerations. Clin Anat 2017; 31:259-268. [PMID: 29082570 DOI: 10.1002/ca.23004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/14/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
Abstract
Vein of Galen (VG) aneurysmal malformations (VGAMs) are complex vascular lesions. Their etiopathogenesis is extensively debated and remains poorly understood. Strictly speaking, true VGAMs are Galenic pial arteriovenous fistulas. They are believed to arise in utero and are contended to drain either into the true VG or the median prosencephalic vein of Markowski. Several classification systems have been proposed and are widely used. With the advent of endovascular therapy, precise understanding of the angioarchitecture is critical for management and therapeutic decision making. We review clinical presentation and diagnostic imaging findings, discussing angioarchitectural properties as they relate to treatment planning. Clin. Anat. 31:259-268, 2018. © 2017 Wiley Periodicals, Inc.
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22
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Saliou G, Vraka I, Teglas JP, Senat MV, Durand P, Colmant C, Ozanne A, Martinovic J, Tissiere P, Adamsbaum C. Pseudofeeders on fetal magnetic resonance imaging predict outcome in vein of Galen malformations. Ann Neurol 2017; 81:278-286. [DOI: 10.1002/ana.24873] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 12/19/2016] [Accepted: 12/26/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Guillaume Saliou
- Department of Neuroradiology, Bicêtre Hospital; Le Kremlin-Bicêtre
- Department of Neuroradiology; CHUV, Lausanne University Hospital; Lausanne
| | - Irène Vraka
- Department of Pediatric Radiology, Bicêtre Hospital; Le Kremlin-Bicêtre
| | - Jean-Paul Teglas
- Center for Research in Epidemiology and Population Health, National Institute of Health and Medical Research, Faculty of Medicine; University of Paris-Sud; Le Kremlin-Bicêtre
| | - Marie-Victoire Senat
- Department of Obstetric Gynecology and Antenatal Diagnostics; Bicêtre Hospital; Le Kremlin-Bicêtre
| | - Philippe Durand
- Pediatric Resuscitation, Bicêtre Hospital; Le Kremlin-Bicêtre
| | - Claire Colmant
- Department of Obstetric Gynecology and Antenatal Diagnostics; Bicêtre Hospital; Le Kremlin-Bicêtre
| | - Augustin Ozanne
- Department of Neuroradiology, Bicêtre Hospital; Le Kremlin-Bicêtre
| | | | - Pierre Tissiere
- Pediatric Resuscitation, Bicêtre Hospital; Le Kremlin-Bicêtre
| | - Catherine Adamsbaum
- Department of Neuroradiology; CHUV, Lausanne University Hospital; Lausanne
- Faculty of Medicine; University of Paris-Sud, Le Kremlin-Bicêtre; Paris France
- Laboratory of Information Processing and Communication, National Center for Scientific Research, Télécom ParisTech; University of Paris-Saclay; Paris France
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23
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Ramgren B, Rask O, Gelberg J, Liuba P, Undrén P, Wassélius J. Endovascular treatment of vein of Galen aneurysmal malformation using rapid ventricular pacing: A case report. Interv Neuroradiol 2016; 23:97-101. [PMID: 27837112 DOI: 10.1177/1591019916676624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The treatment of choice of vein of Galen aneurysmal malformation (VGAM) involves endovascular procedures that can be difficult to perform in high-flow fistulas. We describe the use of rapid ventricular pacing (RVP), a well-known cardiologic technique, to safely treat a high-flow fistula in an infant with VGAM.
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Affiliation(s)
- Birgitta Ramgren
- 1 Department of Diagnostic Radiology, Clinical Sciences Lund, Faculty of Medicine, Lund University and Skåne University Hospital, Sweden
| | - Olof Rask
- 2 Department of Pediatrics, Clinical Sciences Lund, Faculty of Medicine, Lund University and Skåne University Hospital, Sweden
| | - Jan Gelberg
- 3 Department of Pediatric Anesthesiology and Intensive Care, Clinical Sciences Lund, Faculty of Medicine, Lund University and Skåne University Hospital, Sweden
| | - Petru Liuba
- 2 Department of Pediatrics, Clinical Sciences Lund, Faculty of Medicine, Lund University and Skåne University Hospital, Sweden
| | - Per Undrén
- 1 Department of Diagnostic Radiology, Clinical Sciences Lund, Faculty of Medicine, Lund University and Skåne University Hospital, Sweden
| | - Johan Wassélius
- 1 Department of Diagnostic Radiology, Clinical Sciences Lund, Faculty of Medicine, Lund University and Skåne University Hospital, Sweden
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Priyadarshi A, Luig M. Vein of Galen aneurysmal malformation: Pit-falls in the diagnosis. Australas J Ultrasound Med 2016; 19:160-163. [DOI: 10.1002/ajum.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Archana Priyadarshi
- The Neonatal Intensive Care Unit; Westmead Hospital; P.O Box 533 Wentworthville New South Wales 2145 Australia
| | - Melissa Luig
- The Neonatal Intensive Care Unit; Westmead Hospital; P.O Box 533 Wentworthville New South Wales 2145 Australia
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Elijovich L, Choudhri AF, Arthur AS, Klimo P, Boop FA, Berenstein A. Retreatment of a choroidal vein of Galen malformation with embolization 42 years after open surgical treatment in the neonatal period. BMJ Case Rep 2016; 2016:bcr-2016-012709. [PMID: 27702926 DOI: 10.1136/bcr-2016-012709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In 1976 an infant boy initially presented with a choroidal vein of Galen malformation (cVOGM). Craniotomy and clipping of the anterior cerebral artery and posterior choroidal arteries was performed, which was reported in the literature 40 years ago. The patient remained asymptomatic until age 42 when he re-presented with an isolated intraventricular hemorrhage. Angiography demonstrated cVOGM with venous sinus occlusive disease leading to venous hypertension and subsequent intraventricular hemorrhage. The angiogram also demonstrated a 'pseudo-nidus' composed of multiple arterial-to-arterial anastomoses that had developed as a result of the original surgical treatment. We embolized a portion of the lesion to reduce the venous hypertension. The patient has been asymptomatic for more than 2 years. To our knowledge, this is the first reported case of a symptomatic neonatal VOGM treated with open surgery that required embolization as an adult for a delayed hemorrhagic presentation.
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Affiliation(s)
| | - Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Paul Klimo
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | | | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Hafez A, Numminen J, Rahul R, Järveläinen J, Niemelä M. Perimesencephalic subarachnoid hemorrhage with a positive angiographic finding: case report and review of the literature. Acta Neurochir (Wien) 2016; 158:1045-9. [PMID: 27106848 DOI: 10.1007/s00701-016-2801-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/04/2016] [Indexed: 11/29/2022]
Abstract
The vast majority of perimesencephalic subarachnoid hemorrhage cases are reported as negative-finding etiologies. Recently, high-resolution images allowed us to overcome the previous difficulty of finding the source of bleeding, which underlies the concept of a "negative finding". We discovered a venous etiology, hidden behind the tip of the basilar artery; namely, the lateral pontine vein. Here, we review the literature on perimesencephalic subarachnoid hemorrhage and on venous aneurysm. We highlight this type of aneurysm as a candidate source of perimesencephalic hemorrhage. This case may change our way of dealing with what we have termed a negative finding of subarachnoid hemorrhage.
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Affiliation(s)
- Ahmad Hafez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PB-266, 00029, Hus, Finland.
| | - Jussi Numminen
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PB-266, 00029, Hus, Finland
| | - Raj Rahul
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PB-266, 00029, Hus, Finland
| | - Juha Järveläinen
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PB-266, 00029, Hus, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PB-266, 00029, Hus, Finland
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Hansen D, Kan PT, Reddy GD, Mohan AC, Jea A, Lam S. Pediatric knowledge update: Approach to the management of vein of Galen aneurysmal malformations in neonates. Surg Neurol Int 2016; 7:S317-21. [PMID: 27274404 PMCID: PMC4879847 DOI: 10.4103/2152-7806.182415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/26/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- Daniel Hansen
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Peter T Kan
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Gaddum D Reddy
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Arvind Chintagumpala Mohan
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Andrew Jea
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sandi Lam
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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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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Kütük MS, Doğanay S, Özdemir A, Görkem SB, Öztürk A. Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating a Vein of Galen Aneurysmal Malformation. Balkan Med J 2016; 33:112-4. [PMID: 26966627 DOI: 10.5152/balkanmedj.2015.151118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 07/10/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The vein of Galen aneurysmal malformation (VGAM) is a rare intracranial vascular malformation which causes end-organ ischemia or venous congestion due to heart failure. Adrenal hemorrhage associated with VGAM has not been reported in the literature. We present the imaging findings of a fetal VGAM with adrenal hemorrhage. CASE REPORT A 26 year-old primigravida woman whose fetus with VGAM and mild cardiomegaly was scanned in the 34th week. On fetal ultrasound, a hyperechoic, well-circumscribed mass in the left suprarenal region was shown. Fetal and postnatal magnetic resonance imaging confirmed the diagnosis of adrenal hemorrhage. The baby died after delivery. CONCLUSION Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the adrenal gland in affected cases may contribute to the prenatal counseling, and postnatal management.
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Affiliation(s)
- Mehmet Serdar Kütük
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Selim Doğanay
- Department of Radiology, Division of Pediatric Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ahmet Özdemir
- Department of Pediatrics, Division of Neonatalogy, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Süreyya Burcu Görkem
- Department of Radiology, Division of Pediatric Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Adnan Öztürk
- Department of Pediatrics, Division of Neonatalogy, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Iizuka T, Arai T, Myojo S, Uchiyama N, Yoshida K, Fujiwara H. Post-delivery evaluation of morphological change in vein of galen aneurysmal malformation – possible parameter of long-term prognosis. CASE REPORTS IN PERINATAL MEDICINE 2016. [DOI: 10.1515/crpm-2015-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation of the central nervous system. Although recent advances in the endovascular treatment and management of neonatal heart failure have resulted in reduced mortality and morbidity, the long-term neurodevelopmental prognosis is not well described. We encounterred a case of prenatally diagnosed VGAM, which was successfully treated, resulting in a favorable neurodevelopmental outcome. In this case, although an emergency intravascular operation was performed due to the post-delivery exacerbation of heart failure, the aneurysmal volume evaluated by magnetic resonance imaging just before the operation was not increased as compared with the prenatal value assessed by ultrasonography. This suggests that the stability of the VGAM volume even under exacerbation of heart failure is a potential parameter to predict the long-term neurodevelopmental prognosis.
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Affiliation(s)
- Takashi Iizuka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Kanazawa University 13-1 Takaramachi, Kanazawa, Japan
| | - Takanari Arai
- Department of Obstetrics and Gynecology, Keiju Genenal Hospital, Nanao, Ishikawa 920-8641, Japan
| | - Subaru Myojo
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Kanazawa University 13-1 Takaramachi, Kanazawa, Japan
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University 13-1 Takaramachi, Kanazawa, Japan
| | - Kotaro Yoshida
- Department of Radiology, Graduate School of Medicine, Kanazawa University 13-1 Takaramachi, Kanazawa, Japan
| | - Hiroshi Fujiwara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Kanazawa University 13-1 Takaramachi, Kanazawa, Japan
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Saliou G, Dirks P, Sacho RH, Chen L, terBrugge K, Krings T. Decreased Superior Sagittal Sinus Diameter and Jugular Bulb Narrowing Are Associated with Poor Clinical Outcome in Vein of Galen Arteriovenous Malformation. AJNR Am J Neuroradiol 2016; 37:1354-8. [PMID: 26915567 DOI: 10.3174/ajnr.a4697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 12/16/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Few clinical and imaging findings are known to be associated with poor outcome in neonates and infants with vein of Galen arteriovenous malformations. In the present consecutive series of 35 patients, we evaluated both the diameter of the superior sagittal sinus at onset and the diameter of the jugular bulb on follow-up as potential factors related to poor outcome. MATERIALS AND METHODS Thirty-five consecutive neonates and infants who were prospectively collected in a single-center data base were included in this review. Outcome was assessed by using the Bicêtre Outcome Score. Both the absolute diameter of the superior sagittal sinus and its ratio to the biparietal diameter were measured at onset, compared with age-matched controls, and correlated to patient outcome. RESULTS The diameter of the superior sagittal sinus at onset and its ratio to the biparietal diameter were significantly smaller in the vein of Galen arteriovenous malformation population compared with the matched population (P = .0001) and were correlated significantly with a risk of poor clinical outcome (P = .008). Development of jugular bulb narrowing was also related to poor clinical outcome (P < .0001). CONCLUSIONS Decreased superior sagittal sinus diameter may reflect a decrease of cerebral blood flow due to cerebral arterial steal and intracranial hydrovenous disorders. This finding may be considered cerebral blood flow deterioration and thus taken into consideration in the management decisions for patients with vein of Galen arteriovenous malformations. Likewise, our data suggest that progressive jugular bulb narrowing may indicate earlier intervention to prevent severe narrowing.
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Affiliation(s)
- G Saliou
- From the Department of Neuroradiology (G.S., R.H.S., L.C., K.T., T.K.), Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada Department of Neuroradiologie (G.S.), Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France
| | - P Dirks
- Division of Neurosurgery (P.D.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - R H Sacho
- From the Department of Neuroradiology (G.S., R.H.S., L.C., K.T., T.K.), Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - L Chen
- From the Department of Neuroradiology (G.S., R.H.S., L.C., K.T., T.K.), Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - K terBrugge
- From the Department of Neuroradiology (G.S., R.H.S., L.C., K.T., T.K.), Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
| | - T Krings
- From the Department of Neuroradiology (G.S., R.H.S., L.C., K.T., T.K.), Toronto Western Hospital and University Health Network, Toronto, Ontario, Canada
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KOMIYAMA M, TERADA A, ISHIGURO T. Neuro-Interventions for the Neonates with Brain Arteriovenous Fistulas: With Special Reference to Access Routes. Neurol Med Chir (Tokyo) 2016; 56:132-40. [PMID: 26853455 PMCID: PMC4791307 DOI: 10.2176/nmc.oa.2015-0336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/11/2016] [Indexed: 11/20/2022] Open
Abstract
Neonatal neuro-intervention is challenging. The purpose of this article is to report the neuro-intervention for the neonates with brain arteriovenous fistulas (AVFs), with special reference to access routes. Fifteen neonates (12 boys and 3 girls) who underwent neuro-intervention within the first 14 days of life were -included. Their diagnoses included vein of Galen aneurysmal malformation (6), dural sinus malformations with arteriovenous (AV) shunts (6), pial AVF (2), and epidural AVF (1). Birth weight ranged from 1,538 g to 3,778 g (mean 2,525 g). Neuro-interventions, especially access routes, in the neonatal periods (< 1 month) were retrospectively reviewed. All neonates presented with severe cardiac failure. In total, 29 interventions (mean 1.9) were performed within 1 month. Although 12 neonates with birth weight more than 2,700 g could be treated through transfemoral arterial routes, 3 neonates with birth weight less than 2,200 g could not be treated successfully by femoral arterial routes. Interventions were performed through 19 femoral arterial, 3 femoral venous, 2 umbilical arterial, 3 umbilical venous, 3 transcardiac, and 2 direct carotid routes. Their overall outcomes were six good recovery, one moderate disability, two severe disabilities, one vegetative state, and five deaths with a mean follow-up period of 7 years 2 months. Neuro-intervention for the neonates with birth weight more than 2,700 g can be performed by femoral arterial routes using a 4F sheath. For those with birth weight less than 2,200 g, however, alternative access routes are required.
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Affiliation(s)
- Masaki KOMIYAMA
- Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Osaka
| | - Aiko TERADA
- Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Osaka
| | - Tomoya ISHIGURO
- Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Osaka
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Burch EA, Orbach DB. Pediatric central nervous system vascular malformations. Pediatr Radiol 2015; 45 Suppl 3:S463-72. [PMID: 26346152 DOI: 10.1007/s00247-015-3356-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/10/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
Pediatric central nervous system (CNS) vascular anomalies include lesions found only in the pediatric population and also the full gamut of vascular lesions found in adults. Pediatric-specific lesions discussed here include infantile hemangioma, vein of Galen malformation and dural sinus malformation. Some CNS vascular lesions that occur in adults, such as arteriovenous malformation, have somewhat distinct manifestations in children, and those are also discussed. Additionally, children with CNS vascular malformations often have associated broader vascular conditions, e.g., PHACES (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies and sternal anomalies), hereditary hemorrhagic telangiectasia, and capillary malformation-arteriovenous malformation syndrome (related to the RASA1 mutation). The treatment of pediatric CNS vascular malformations has greatly benefited from advances in endovascular therapy, including technical advances in adult interventional neuroradiology. Dramatic advances in therapy are expected to stem from increased understanding of the genetics and vascular biology that underlie pediatric CNS vascular malformations.
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Affiliation(s)
- Ezra A Burch
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
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Common procedures and strategies for anaesthesia in interventional radiology. Curr Opin Anaesthesiol 2015; 28:458-63. [DOI: 10.1097/aco.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Yan J, Wen J, Gopaul R, Zhang CY, Xiao SW. Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis. J Neurosurg 2015; 123:872-90. [PMID: 26230476 DOI: 10.3171/2014.12.jns141249] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECT There have been many multidisciplinary approaches to the treatment of vein of Galen malformations. Endovascular embolization is the first option for treatment. However, the effects of the treatment remain controversial. The aim of this study is to assess the efficacy and safety of endovascular embolization to treat patients with vein of Galen malformations. METHODS This paper includes a retrospective analysis of a sample of 667 patients who underwent endovascular embolization to treat vein of Galen malformations. The data were obtained through a literature search of PubMed databases. The authors also evaluate the efficacy and safety of the treatment. Mortality within the follow-up period is analyzed. Pooled estimates of proportions with corresponding 95% CIs were calculated using raw (i.e., untransformed) proportions (PRAW). RESULTS In the 34 studies evaluated, neonates accounted for 44% of the sample (95% CI 31%-57%; I(2) = 92.5%), infants accounted for 41% (95% CI 30%-51%; I(2) = 83.3%), and children and adults accounted for 12% (95% CI 7%-16%; I(2) = 52.9%). The meta-analysis revealed that complete occlusion was performed in 57% (95% CI 48%-65%; I(2) = 68.2%) of cases, with partial occlusion in 43% (95% CI 34%-51%; I(2) = 70.7%). The pooled proportion of patients showing a good outcome was 68% (95% CI 61%-76%; I(2) = 77.8%), while 31% showed a poor outcome (95% CI 24%-38%; I(2) = 75.6%). The proportional meta-analysis showed that postembolization mortality and complications were reported in 10% (95% CI 8%-12%; I(2) = 42.8%) and 37% (95% CI 29%-45%; I(2) = 79.1%), respectively. Complications included cerebral hemorrhage, cerebral ischemia, hydrocephalus, leg ischemia, and vessel perforation. CONCLUSIONS The successful treatment of vein of Galen malformations remains a complex therapeutic challenge. The authors' analysis of clinical history and research literature suggests that vein of Galen malformations treated with endovascular embolization can result in an acceptable mortality rate, complications, and good clinical outcome. Future large-scale, multicenter, randomized trials are necessary to confirm these findings.
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Affiliation(s)
- Jun Yan
- Departments of 1 Neurosurgery and
| | - Jing Wen
- Rheumatism, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Flow control using Scepter™ balloons for Onyx embolization of a vein of Galen aneurysmal malformation. Childs Nerv Syst 2015; 31:135-40. [PMID: 25358810 DOI: 10.1007/s00381-014-2576-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We present a technical development of the endovascular treatment technique for vein of Galen aneurysmal malformation, using Onyx™ (ethylene vinyl alcohol copolymer) delivered under flow control through double-lumen balloon microcatheters. MATERIALS AND METHODS An 11-month-old patient that initially presented with increasing head circumference was diagnosed with mural type vein of Galen aneurysmal malformation. Complete cure was obtained in a single endovascular treatment session. Onyx was delivered simultaneously through two double-lumen balloon microcatheters (Scepter™, Microvention, Terumo Group). In both arterial feeders, balloon inflation occluded the high-flow arterial-venous shunting and thus facilitated the controlled propagation of the embolic product in the afferent artery and the shunt point while preventing distal migration into the venous system. RESULTS Two years post-procedure, MR imaging showed persistent occlusion of arterial-venous shunts with complete regression of the venous dilatation. On clinical examination, the patient had no neurological deficits, and no cognitive impairment was detected at neuropsychological testing. CONCLUSION The use of double-lumen balloon microcatheters for flow control during delivery of Onyx represents a viable alternative for the endovascular treatment of vein of Galen aneurysmal malformations.
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Uzun O, Babaoglu K, Ayhan YI, Moselhi M, Rushworth F, Morris S, Beattie B, Wiener J, Lewis MJ. Diagnostic ultrasound features and outcome of restrictive foramen ovale in fetuses with structurally normal hearts. Pediatr Cardiol 2014; 35:943-52. [PMID: 24585219 DOI: 10.1007/s00246-014-0879-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/04/2014] [Indexed: 11/28/2022]
Abstract
Intrauterine foramen ovale (FO) restriction in association with congenital heart disease (CHD) carries a poor prognosis. However, in the absence of CHD, the clinical importance of restrictive FO in the fetus is not well understood. We evaluated the antenatal prevalence, clinical presentation, diagnostic ultrasound features, and outcome of restrictive FO in fetuses without CHD. We reviewed the echocardiographic and clinical records of 23 fetuses diagnosed with a restrictive FO and structurally normal heart between 2001 and 2012. The atrial septum, dimensions of cardiac structures, left and right cardiac output and Doppler interrogation of cardiac flows were examined. The clinical outcomes of all fetuses with restrictive FO were analysed. Restrictive FO was identified in 23 of 1,682 (1.4%) fetuses with no CHD. Enlarged right heart structures (100%), hypermobile or redundant primum atrial septum (91%), increased right-to-left ventricular cardiac output ratio (91%), and posteriorly angulated ductus arteriosus (68%) were the most common echocardiographic findings associated with this rare phenomenon. Additional noncardiac systemic abnormalities were identified in 13 (56%) babies. Seven (30%) neonates developed persistent pulmonary hypertension, and 7 infants died. Antenatal restrictive FO is an underrecognised entity despite being a common cause of right heart dilatation in the fetus. In the absence of CHD, restrictive FO is well tolerated antenatally, but its frequent association with noncardiac abnormalities and pulmonary hypertension in the neonate are noteworthy.
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Affiliation(s)
- Orhan Uzun
- Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, UK,
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Chow ML, Cooke DL, Fullerton HJ, Amans MR, Narvid J, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Radiological and clinical features of vein of Galen malformations. J Neurointerv Surg 2014; 7:443-8. [PMID: 24789593 DOI: 10.1136/neurintsurg-2013-011005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/07/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Vein of Galen malformations (VOGMs) are rare and complex congenital arteriovenous fistulas. The clinical and radiological features of VOGMs and their relation to clinical outcomes are not fully characterized. OBJECTIVE To examine the clinical and radiological features of VOGMs and the predictors of outcome in patients. METHODS We retrospectively reviewed the available imaging and medical records of all patients with VOGMs treated at the University of California, San Francisco between 1986 and 2013. Radiological and clinical features were identified. We applied the modified Rankin Scale to determine functional outcome by chart review. Predictors of outcome were assessed by χ(2) analyses. RESULTS Forty-one cases were confirmed as VOGM. Most patients (78%) had been diagnosed with VOGM in the first year of life. Age at treatment was bimodally distributed, with predominantly urgent embolization at <10 days of age and elective embolization after 1 year of age. Patients commonly presented with hydrocephalus (65.9%) and congestive heart failure (61.0%). Mixed-type (31.7%) VOGM was more common in our cohort than purely mural (29.3%) or choroidal (26.8%) types. The most common feeding arteries were the choroidal and posterior cerebral arteries. Transarterial embolization with coils was the most common technique used to treat VOGMs at our institution. Functional outcome was normal or only mildly disabled in 50% of the cases at last follow-up (median=3 years, range=0-23 years). Younger age at first diagnosis, congestive heart failure, and seizures were predictive of adverse clinical outcome. The survival rate in our sample was 78.0% and complete thrombosis of the VOGM was achieved in 62.5% of patients. CONCLUSIONS VOGMs continue to be challenging to treat and manage. Nonetheless, endovascular approaches to treatment are continuing to be refined and improved, with increasing success. The neurodevelopmental outcomes of affected children whose VOGMs are treated may be good in many cases.
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Affiliation(s)
- Maggie L Chow
- School of Medicine, University of California, San Francisco Medical School, San Francisco, California, USA
| | - Daniel L Cooke
- Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA
| | - Jared Narvid
- Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA
| | - Christopher F Dowd
- Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA
| | - Randall T Higashida
- Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA
| | - Van V Halbach
- Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA
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Roccatagliata L, Bracard S, Holmin S, Soderman M, Rodesch G. Pediatric intracranial arteriovenous shunts: a global overview. Childs Nerv Syst 2013; 29:907-19. [PMID: 23624781 DOI: 10.1007/s00381-013-2114-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cerebral arteriovenous shunts (CAVS) in the pediatric population cannot be compared to those in adults as they present different anatomical, physiological, and pathological characteristics concerning the arterial and venous vasculature and the cerebrospinal fluid physiology. These lesions develop in a maturing brain, of which expression is difficult to assess, with a potential for recovery different from that in adults. DISCUSSION Their impact on the brain will be different in the antenatal period, in neonates, in infants, and in children, with variable symptoms according to each age group. We review different classifications of pediatric CAVS (according to the anatomical space in which they develop, their type and architecture, and the age at which they reveal), describe their evolution, and discuss the current role of endovascular treatment in the management of these vascular lesions.
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Affiliation(s)
- Luca Roccatagliata
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, 40 Rue Worth, Suresnes, France
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Prise en charge des malformations vasculaires cérébrales découvertes en période ante- ou néonatale. Arch Pediatr 2013; 20:74-81. [DOI: 10.1016/j.arcped.2012.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/02/2012] [Accepted: 10/26/2012] [Indexed: 11/22/2022]
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Ellis JA, Orr L, II PCM, Anderson RCE, Feldstein NA, Meyers PM. Cognitive and functional status after vein of Galen aneurysmal malformation endovascular occlusion. World J Radiol 2012; 4:83-9. [PMID: 22468188 PMCID: PMC3314932 DOI: 10.4329/wjr.v4.i3.83] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/02/2012] [Accepted: 01/09/2012] [Indexed: 02/06/2023] Open
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 Scale-Revised, 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. During 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.
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Brierley J, Hasan A. Aspects of deceased organ donation in paediatrics. Br J Anaesth 2012; 108 Suppl 1:i92-5. [PMID: 22194438 DOI: 10.1093/bja/aer405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Organ transplantation offers children in acute or chronic severe organ failure similar opportunities to adults. However, while the number who might benefit is relatively low, significantly fewer cadaveric donors exist for any given child compared with an adult. Incompatible organ size and relatively low donation rates mean that despite living parental donation and innovations to reduce donated organ size, children die before organs become available. The severity of the UK situation is compounded by restrictions on paediatric living donation, uncertainties over the application of brain death criteria, and ethical concerns about the use of donation after circulatory death. The UK Department of Health's Organ Donation Task Force suggested the means by which the adult donor pool might be increased, recommending that outstanding ethical and legal issues be resolved, but made no specific recommendations about children.
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Affiliation(s)
- J Brierley
- Paediatric and Neonatal intensive Care London, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK.
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