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Naggara O, Stirnemann J, Boulouis G, Orbach DB, Grévent D, James S, Boddaert N, Kossorotoff M, Blauwblomme T, Ville Y. Prenatal treatment of a vein of Galen malformation by embolization and 1-year follow-up. Am J Obstet Gynecol 2024; 230:372-374. [PMID: 38043773 DOI: 10.1016/j.ajog.2023.11.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Olivier Naggara
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, INSERM U1266, Université Paris-Cité, Paris, France; Department of Pediatric Radiology, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Cité, Paris, France
| | - Julien Stirnemann
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades University Hospital, Université Paris-Cité, Paris, France
| | - Gregoire Boulouis
- Department of Pediatric Radiology, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Cité, Paris, France
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - David Grévent
- Department of Pediatric Radiology, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Cité, Paris, France
| | - Syril James
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Cité, Institut Imagine, INSERM UMR 1163, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Cité, Paris, France
| | - Manoëlle Kossorotoff
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades University Hospital, Université Paris-Cité, Paris, France; Department of Pediatric Neurology, French Centre for Pediatric Stroke, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Cité, Institut Imagine, INSERM UMR 1163, Paris, France
| | - Yves Ville
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades University Hospital, Université Paris-Cité, Paris, France.
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Orbach DB, Wilkins-Haug LE, Benson CB, Rangwala SD, Pak C, Saffarzadeh M, Weinstock P. Overcoming roadblocks in clinical innovation via high fidelity simulation: use of a phantom simulator to achieve FDA and IRB approval of a clinical trial of fetal embolization of vein of Galen malformations. J Neurointerv Surg 2023; 15:1218-1223. [PMID: 36690441 DOI: 10.1136/jnis-2022-019658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Vein of Galen malformation (VOGM) is a rare, life-threatening vascular malformation in neonates and is treated with embolization. However, even at the most experienced centers, patients face high mortality and morbidity. In utero treatment options have been limited by lack of animal models or simulations. OBJECTIVE To create a novel ultrasound phantom simulator for a preclinical feasibility study of in utero fetal intervention for VOGM. METHODS Novel phantoms were designed and built in two configurations of spherical and windsock shape from cryogel material to mimic the salient vasculature of the fetal VOGM, based on real-patient fetal MR imaging dimensions. Critical anatomy was realistically mimicked within this model and transtorcular ultrasound-guided coil deployment was simulated. Each phantom model was assessed before and after treatment to evaluate coil mass deposition within the target. RESULTS The two phantoms underwent pretreatment T2-weighted MR imaging assessment, ultrasound-guided embolization, post-treatment MR and fluoroscopic imaging, and visual inspection of the sliced phantoms for target embolization verification. Postoperative MR scans confirmed realistic compact deposition of the coil masses within the central cavity. Phantom embolization results were submitted as part of the institutional review board and US Food and Drug Administration investigative device exemption approval for a first-in-humans clinical trial of fetal intervention for VOGM. CONCLUSIONS A phantom simulator for fetal intervention of VOGM produces lifelike results during trial interventions, removing obstacles to feasibility and safety evaluations, typically precluded by non-availability of appropriate animal models. The study provides a proof of concept for potentially wider applications of medical simulation to enable novel procedural advancements in neurointerventions.
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Affiliation(s)
- Darren B Orbach
- Department of Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Louise E Wilkins-Haug
- Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shivani D Rangwala
- Department of Neurological Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Christopher Pak
- Boston Children's Hospital Simulator Program (SIMPeds), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mona Saffarzadeh
- Boston Children's Hospital Simulator Program (SIMPeds), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Peter Weinstock
- Department of Anesthesia, BCH Simulator Program, Boston Children's Hospital, Boston, Massachusetts, USA
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Rangwala SD, Johnson K, See AP, Smith ER, Orbach DB. Direct Transverse Sinus Puncture for Transvenous Coil Embolization of Vein of Galen Malformations: Innovating Existing Techniques. Oper Neurosurg (Hagerstown) 2023; 25:e352-e358. [PMID: 37819101 DOI: 10.1227/ons.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Vein of Galen malformations (VOGMs) are complex arteriovenous malformations in neonates and young children. Recent advances in endovascular interventions have drastically improved treatment and clinical outcomes in what was previously high-morbidity, high-mortality disease. The high-flow shunt pathophysiology in VOGMs can lead to dynamic changes in the malformation angioarchitecture, and over time patients can develop jugular bulb stenosis. In the setting of inaccessible transvenous access to the malformation for endovascular embolization in cases where transarterial embolization is inadequate, a combined surgical and endovascular technique must be used. We present the first successful modern-day application of direct puncture through transverse sinus for transvenous embolization of a VOGM. CLINICAL PRESENTATION We present 2 unique cases of complex VOGM malformations in patients who had previously undergone staged endovascular embolization for reduction of flow within the malformation. On follow-up, in both cases, there was development of severe sigmoid sinus and jugular bulb stenosis, increasing intracranial venous congestion and causing marked clinical deterioration. The stenosis prevented traditional transvenous access and treatment. We describe a direct puncture transverse sinus access using a burr hole approach for endovascular transvenous embolization in both cases with successful clinical outcomes. CONCLUSION Direct access using burr hole craniotomy to the transverse sinus for transvenous endovascular embolization is a safe approach in the setting of severe jugular bulb stenosis for treatment of VOGMs. This technique can be done efficiently to achieve complete flow elimination in the malformation, in cases where that is called for, without significant risks or complications related to the approach.
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Affiliation(s)
- Shivani D Rangwala
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Kristin Johnson
- Vascular Biology Program, Boston Children's Hospital, Boston , Massachusetts , USA
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
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Schwarz S, Brevis Nuñez F, Dürr NR, Schlunz-Hendann M, Brassel F, Felderhoff-Müser U, Dohna-Schwake C, Bruns N. Aortic Steal Correlates with Acute Organ Dysfunction and Short-Term Outcomes in Neonates with Vein of Galen Malformation. Neonatology 2023; 121:106-115. [PMID: 37906988 PMCID: PMC10836749 DOI: 10.1159/000534132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Vein of Galen aneurysmal malformation (VGAM) is a rare, congenital cerebrovascular malformation with high morbidity and mortality. Parameters to foresee clinical progression and allow individualized parent counseling are lacking. The aim of this study was to evaluate aortic steal measured by Doppler ultrasound as a prognostic parameter in these neonates. METHODS A retrospective monocentric analysis of cardiac ultrasound exams before embolization in neonates with VGAM was conducted. Percentage of aortic steal measured by time-averaged maximum velocity above and below the zero flow baseline by pulsed Doppler ultrasound at the preductal aortic isthmus was calculated. Association of aortic steal with parameters of acute organ dysfunction (Bicêtre neonatal evaluation score [BNES], neonatal multiple organ dysfunction score [NeoMODS]) and mortality and determination of correlation between aortic steal and cerebral damage on initial and follow-up cerebral magnetic resonance imaging (cMRI) were evaluated. RESULTS Twelve neonates were included, of which 3 died. Per 10 percentage point increase of aortic steal, BNES decreased by 1.64 (95% confidence interval [CI]: 1.28-2.0) points and the maximum observed NeoMODS increased by 1.25 (CI: 0.94-1.57) points. The odds for mortality increased by 2.3 (CI: 1.14-13.67) per 10 percentage point increase of aortic steal. There was a correlation between aortic steal and cerebral damage at baseline (white matter ρ [rho] = 0.34, gray matter ρ = 0.81) and follow-up (white matter ρ = 0.80, gray matter ρ = 0.72). CONCLUSION The degree of aortic steal in neonates with VGAM was highly associated with the severity of organ dysfunction, disease progression on cMRI, and mortality.
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Affiliation(s)
- Simone Schwarz
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Clinics Duisburg, Duisburg, Germany
| | - Francisco Brevis Nuñez
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Clinics Duisburg, Duisburg, Germany
| | - Nikola R Dürr
- Clinic for Radiology and Neuroradiology, Sana Clinics Duisburg, Duisburg, Germany
| | | | - Friedhelm Brassel
- Clinic for Radiology and Neuroradiology, Sana Clinics Duisburg, Duisburg, Germany
- Centre for Pediatric Interventional Radiology/Neuroradiology and Interventional Treatment of Vascular Malformations, Sana Clinics Duisburg, Duisburg, Germany
| | - Ursula Felderhoff-Müser
- Department for Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department for Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department for Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Khurana J, Orbach DB, Gauvreau K, Collins SL, Tella JB, Agrawal PB, Christou HA, Mullen MP. Pulmonary Hypertension in Infants and Children with Vein of Galen Malformation and Association with Clinical Outcomes. J Pediatr 2023; 258:113404. [PMID: 37023946 DOI: 10.1016/j.jpeds.2023.113404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To assess the extent and resolution of pulmonary hypertension (PH), cardiovascular factors, and echocardiographic findings associated with mortality in infants and children with vein of Galen malformation (VOGM). STUDY DESIGN We performed a retrospective review of 49 consecutive children with VOGM admitted to Boston Children's Hospital from 2007 to 2020. Patient characteristics, echocardiographic data, and hospital course were analyzed for 2 cohorts based on age at presentation to Boston Children's Hospital: group 1 (age ≤60 days) or group 2 (age >60 days). RESULTS Overall hospital survival was 35 of 49 (71.4%); 13 of 26 (50%) in group 1 and 22 of 23 (96%) in group 2 (P < .001). High-output PH (P = .01), cardiomegaly (P = .011), intubation (P = .019), and dopamine use (P = .01) were significantly more common in group 1 than group 2. Among patients in group 1, congestive heart failure (P = .015), intubation (P < .001), use of inhaled nitric oxide (P = .015) or prostaglandin E1 (P = .030), suprasystemic PH (P = .003), and right-sided dilation were significantly associated with mortality; in contrast, left ventricular volume and function, structural congenital heart disease, and supraventricular tachycardia were not associated. Inhaled nitric oxide achieved no clinical benefit in 9 of 11 treated patients. Resolution of PH was associated with overall survival (P < .001). CONCLUSIONS VOGM remains associated with substantial mortality among infants presenting at ≤60 days of life owing to factors associated with high output PH. Resolution of PH is an indicator associated with survival and a surrogate end point for benchmarking outcomes.
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Affiliation(s)
- Jai Khurana
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Darren B Orbach
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA; Neurointerventional Radiology, Department of Radiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Shane L Collins
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Joseph B Tella
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Pankaj B Agrawal
- Harvard Medical School, Boston, MA; Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Helen A Christou
- Harvard Medical School, Boston, MA; Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA
| | - Mary P Mullen
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Jones JG, Kane A. Rapid Ventricular Pacing Facilitates Transarterial Embolization in Vein of Galen Malformations. Interv Neuroradiol 2023; 29:183-188. [PMID: 35234073 PMCID: PMC10152818 DOI: 10.1177/15910199221082472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Mural type vein of Galen malformation (mVOGM) is a congenital high flow arteriovenous shunt between choroidal arteries and the prosencephalic vein of Markowski leading to heart failure and hydrovenous disorder in children. Embolizing fistulous connections can be challenging and typically requires adjunctive techniques such as induced hypotension, balloon-assisted flow control, and creation of a coil basket. These maneuvers add time, complexity, and unpredictability. Rapid ventricular pacing (RVP) has been proposed as an alternative strategy with fewer drawbacks, but has not been well studied. The approach involves catheterizing the right ventricle with a pacing catheter connected to a temporary external pacemaker. Prior to embolization, RVP is initiated to lower cardiac output. Following embolization, pacing is discontinued, and the heart returns to sinus rhythm. Methods: We performed RVP in five mVOGM patients from 4/2020 through 7/2021. Accounting for multiple procedures, RVP was utilized in ten cases and twenty-six pedicles. Results: Ventricular capture was achieved in all instances and was well tolerated, without arrhythmia. Casting the arterial pedicle with liquid embolic immediately adjacent to, or traversing, the fistulous point was achieved in 9/10 cases. There were no procedural complications. In 1 case, creation of a coil basket in the venous pouch was required to achieve a stable arterial cast Conclusions: This report describes the largest case series utilizing RVP in mVOGM. The technique appears safe and well tolerated.
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Lu VM, Luther EM, Silva MA, Rangwala SD, Starke RM, Smith ER, See AP. The composition of landmark vein of Galen malformation research: the emergence of endovascular treatments. Childs Nerv Syst 2023; 39:733-741. [PMID: 36149485 DOI: 10.1007/s00381-022-05687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the advent of endovascular treatment, the long-term prognosis of vein of Galen malformation (VOGM) has markedly improved; however, the nature of research leading to this point is unclear. The objective of this study was to define the composition of VOGM research to date, by means of a bibliometric analysis of the 100 most cited VOGM articles. METHODS An electronic search of Elsevier's Scopus database was performed to identify the 100 most cited articles on VOGM screened against predetermined criteria. Data were then compared. RESULTS The 100 most cited VOGM articles were published between 1974 and 2017 in 38 unique journals and originated from 16 unique countries. Mean citation count and rate were 59.4 citations and 2.9 citations/year, respectively. The USA (n = 42); Hôpital de Bicêtre, France (n = 15); and Dr. Pierre Lasjaunias (n = 16) were the largest individual country, institutional, and author contributors. Compared to the older articles (published < 2000), key differences for newer articles were statistically higher citation rates (P < 0.01), more authors (P < 0.01), higher proportion of endovascular treatment descriptions (P = 0.01), and more originating from Asia Pacific (P < 0.01). CONCLUSIONS From the 100 most cited VOGM articles to date, there has been a noticeable shift from diagnosing VOGM based on the foundational work by Dr. Lasjaunias to understanding how we can model clinical outcomes now that endovascular treatment has become the standard of care. Significant shifts in prognosis are pending, and the current bibliometric data implicate we are on the precipice of more recent works making an impact in the near future.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
| | - Evan M Luther
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Michael A Silva
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Shivani D Rangwala
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Pérez-Oliver T, Vela-Martínez E, Martín-Zamora S. Pulmonary embolism after embolization of vein of Galen. An Pediatr (Barc) 2023; 98:236. [PMID: 36828698 DOI: 10.1016/j.anpede.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 02/25/2023] Open
Affiliation(s)
- Teresa Pérez-Oliver
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Elena Vela-Martínez
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Sergio Martín-Zamora
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Udine M, Croci D, Wasserman J, A Noureldine MH, Monsour M, Vakharia K, Agazzi S. Vein of Galen Malformations in Adults. Clin Neurol Neurosurg 2023; 228:107671. [PMID: 36996672 DOI: 10.1016/j.clineuro.2023.107671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Vein of Galen Malformations (VoGM) are rare vascular malformations, typically seen in pediatric age groups. Even more rarely, VoGM's may be seen later in adulthood. In this case report and systematic review, we provide a thorough description of the current literature as well as provide a case example exploring the diagnosis, imaging, treatment, and management of VoGM in adults. METHODS In accordance with PRISMA guidelines, we performed a systematic literature search for all relevant cases and case series of VoGM in adult patients. The reference list of all articles were reviewed for additional relevant cases. Articles were included if they described a VoGM of a patient over the age of 18 years old and published in English. 149 articles were originally identified and 26 described cases met our inclusion criteria. RESULTS In our literature review we found 26 patients that met our inclusion criteria. We found 14 male patients and 12 female patients. The mean age at presentation was 37.2 years (median=34 years, SD= 13.6 years). The most common presenting symptoms of patient were headache (n = 9), seizure (n = 6), and vomiting (n = 4). Of the 12 cases which clearly reported the subtype of VoGM, the choroidal type was more frequently seen (n = 10) compared to the mural type (n = 2). In 3 patients, the VoGM was thrombosed at time of diagnosis. Of the 26 patients, endovascular treatment was performed most frequently (n = 8) but some received microsurgical treatment (n = 4) or were treated conservatively (n = 6). Other treatment modalities included (ventriculoperitoneal shunt, ventriculostomy) (n = 5). In 3 cases treatment was not specified. In comparison to VoGM seen in pediatric or neonatal populations, VoGM in adults generally resulted in more favorable outcomes with only 2 patients reported to have passed away following treatment. CONCLUSION VoGM remains a rare finding amongst the adult population. Hence, we described the clinical presentation, treatment modalities, and outcomes of the cases described in the English literature. Perhaps due to the rate of thrombosis and the unique angioarchitecture seen in adult VoGM patients, outcomes were generally more favorable than those described in the literature in pediatric or neonate VoGM patients.
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Affiliation(s)
- Matthew Udine
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Davide Croci
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jacob Wasserman
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Molly Monsour
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.
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Hoda M, Lemler M, Cory M. Vein of Galen Aneurysmal Malformation with Anomalous Right Superior Vena Cava to the Left Atrium Leading to Atypical Clinical and Echocardiographic Findings. Pediatr Cardiol 2023; 44:254-259. [PMID: 36418550 DOI: 10.1007/s00246-022-03057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
Vein of Galen aneurysmal malformation (VGAM) is a rare intracranial vascular malformation which typically presents in a critically ill newborn with intractable heart failure, severe pulmonary hypertension, and right heart dilation. We report two unusual cases of neonates with VGAM and anomalous connection of right superior vena cava to the left atrium. Both neonates were diagnosed with VGAM in utero and were clinically stable after birth with dilation of the left atrium and left ventricle and no evidence of pulmonary hypertension. One case with hydrocephalus underwent transcatheter embolization at 1 week of age. The other case without hydrocephalus underwent elective transcatheter embolization at 4 months. We postulate that the presence of a right superior vena cava to the left atrium provides a physiological advantage and counters the left-to-right shunt from the arteriovenous malformation. This provides insight to a potential treatment strategy to improve outcomes in patients with severe heart failure and pulmonary hypertension secondary to VGAM.
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Affiliation(s)
- Mehar Hoda
- Department of Pediatrics, Division of Cardiology, University of Texas Southwestern, 1935 Medical District Dr, Dallas, TX, 75235, USA.
| | - Matthew Lemler
- Department of Pediatrics, Division of Cardiology, University of Texas Southwestern, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Melinda Cory
- Department of Pediatrics, Division of Cardiology, University of Texas Southwestern, 1935 Medical District Dr, Dallas, TX, 75235, USA
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Shigematsu T, Bazil MJ, Matsoukas S, Chapot R, Sorscher M, Fifi JT, Berenstein A. Transvenous embolization of vein of galen aneurysmal malformations using the "Chapot pressure cooker" technique. Interv Neuroradiol 2022; 28:655-659. [PMID: 34939504 PMCID: PMC9706271 DOI: 10.1177/15910199211066986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
METHODS Two patients, one 5-year-old and one 7-year-old, both presented with congestive heart failure in the newborn period and were subsequently treated in the newborn period with multiple, staged TAEs with n-BCA for choroidal VGAMs. RESULTS We achieved progressive reduction in shunting and flow but were unable to accomplish complete closure of the malformation: in both patients, a small residual with numerous perforators persisted. The decision was made to perform TVE using the CHPC. In this technique, a guiding catheter is placed transjugular into the straight sinus (SS). One or two detachable tip microcatheters are advanced to the origin of the SS. Another microcatheter is advanced and the tip placed between the distal marker and the detachment zone of the former. Coils and n-BCA are used to prevent reflux of Onyx. CONCLUSIONS In this study, we recognized two important factors of traditional VGAM treatment that may cause interventionalists to consider the ChPC to treat VGAM: (1) without liquid embolic, deployed coils may not occlude the fistula entirely. (2) There is the concern of causing delayed bleeding should the arterial component of the fistula rupture. ChPC ameliorates these issues by offering complete closure of the fistula with liquid embolic material in TVE.
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Affiliation(s)
- Tomoyoshi Shigematsu
- Cerebrovascular Center, Department of Neurosurgery, Mount Sinai Health System, New York, USA
| | - Maximilian J Bazil
- Cerebrovascular Center, Department of Neurosurgery, Mount Sinai Health System, New York, USA
| | - Stavros Matsoukas
- Cerebrovascular Center, Department of Neurosurgery, Mount Sinai Health System, New York, USA
| | - Rene Chapot
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried
Krupp Krankenhaus Rüttenscheid, Essen, Germany
| | - Michelle Sorscher
- Cerebrovascular Center, Department of Neurosurgery, Mount Sinai Health System, New York, USA
| | - Johanna T Fifi
- Cerebrovascular Center, Department of Neurosurgery, Mount Sinai Health System, New York, USA
| | - Alejandro Berenstein
- Cerebrovascular Center, Department of Neurosurgery, Mount Sinai Health System, New York, USA
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Shigematsu T, Bazil MJ, Fifi JT, Berenstein A. Fine, Vascular Network Formation in Patients with Vein of Galen Aneurysmal Malformation. AJNR Am J Neuroradiol 2022; 43:1481-1487. [PMID: 36137661 PMCID: PMC9575532 DOI: 10.3174/ajnr.a7649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE A vein of Galen aneurysmal malformation is known to present with recruitment of dural feeders and, in our cohort, a fine, vascular network formation. The vessels we have observed differ from dural vascular recruitment in that they produce a hairlike, collateral network of vessels. We reviewed treatment courses of vein of Galen aneurysmal malformation treatments in a series of 36 cases that displayed a fine, vascular network formation. MATERIALS AND METHODS We retrospectively analyzed 36 cases of vein of Galen aneurysmal malformation, including tectal/thalamic AVMs, treated at our center from January 2004 to September 2021, and reviewed fine, vascular network formations in the subarachnoid space and subependymal zone alongside the vein of Galen aneurysmal malformation. RESULTS Patients at first endovascular treatment ranged from neonates to 157 months (median age, 4.3 months). Patients with preinterventional fine, vascular network formations were significantly older at the initial angiogram than patients with postinterventional fine, vascular network formations (P < .05). On average, for 20 control choroidal/mural vein of Galen aneurysmal malformations whose treatment course had been completed and in which no plexiform network was visualized, a mean of 2.63 (SD, 1.64) treatments were required to achieve a radiographic cure. For the 36 choroidal/mural vein of Galen aneurysmal malformations whose treatment course had been completed and in which a fine, vascular network formation was visualized, a mean of 5.94 (SD, 2.73) treatments were required to achieve a radiographic cure (P < .01). CONCLUSIONS Development of a fine, vascular network formation is an acquired and reversible phenomenon that differs from typical dural vessel recruitment, given the hairlike nature of the network and its rapid onset postinterventionally. It typically resolves after completion of treatment, and this resolution correlates with closure of the vein. We recommend that neurointerventionalists avoid delays in treatment wherever possible to reduce the likelihood of a fine, vascular network formation.
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Affiliation(s)
- T Shigematsu
- From the Departments of Neurosurgery (T.S., M.J.B., J.T.F., A.B.)
| | - M J Bazil
- From the Departments of Neurosurgery (T.S., M.J.B., J.T.F., A.B.)
| | - J T Fifi
- From the Departments of Neurosurgery (T.S., M.J.B., J.T.F., A.B.)
- Neurology (J.T.F.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - A Berenstein
- From the Departments of Neurosurgery (T.S., M.J.B., J.T.F., A.B.)
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See AP, Wilkins-Haug LE, Benson CB, Tworetzky W, Orbach DB. Percutaneous transuterine fetal cerebral embolisation to treat vein of Galen malformations at risk of urgent neonatal decompensation: study protocol for a clinical trial of safety and feasibility. BMJ Open 2022; 12:e058147. [PMID: 35613814 PMCID: PMC9174825 DOI: 10.1136/bmjopen-2021-058147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Although endovascular techniques have improved outcomes in vein of Galen malformations (VOGM), there is still a high rate of morbidity and mortality, particularly among cases with decompensation in the neonatal period. The dimension of the draining venous sinus on fetal imaging correlates with the risk of neonatal decompensation. In fetuses within this high-risk group who do not have end-organ injury, there is a theoretical therapeutic opportunity to reduce the arteriovenous shunt before the normal physiological changes of birth precipitate decompensation. This study investigates the safety and potential benefit of treating a VOGM in utero, which has not been previously studied. METHODS AND ANALYSIS This study aims to enroll 20 subjects: pregnant women with a fetus harbouring a high-risk VOGM (defined on MRI by a narrowest medial-lateral width greater than 8 mm in the draining venous sinus). Unfortunately, the subset of fetuses with in utero end-organ injury is ineligible, because the late stage of pathology is not amenable to recovery from a cerebrovascular intervention, likely not even in utero. This study aims to alter the physiology before such developments accrue.At or after 23 weeks of gestation, a transuterine transposterior fontanelle needle puncture to the torcular allows ultrasound-guided deployment of coils to embolise the draining venous malformation.This study has 97.5% power to detect major safety events at 30% or greater, and 80% power to detect a reduction in the rate of neonatal intervention from 80% to 30%. In the staged study design, an interval evaluation after 11 patients invokes study termination if safety events occur above the allowed threshold. ETHICS AND DISSEMINATION The institutional review boards at Mass General Brigham and Boston Children's Hospital (BCH) reviewed and approved this protocol. The BCH Department of Radiology and a patient family philanthropic donation fund this study. The trial results will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT04434729.
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Affiliation(s)
- Alfred Pokmeng See
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Louise E Wilkins-Haug
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Darren B Orbach
- Department of Radiology (Neurointerventional), Boston Children's Hospital, Boston, Massachusetts, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Berenstein A, Paramasivam S, Sorscher M, Molofsky W, Meila D, Ghatan S. Vein of Galen Aneurysmal Malformation: Advances in Management and Endovascular treatment. Neurosurgery 2019; 84:469-478. [PMID: 29860355 DOI: 10.1093/neuros/nyy100] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation representing <1% of all arteriovenous malformations. The knowledge and strategies in the management are constantly evolving. OBJECTIVE To review our series of postneonatal VGAM patients treated over 11-yr period. METHODS Retrospective analysis of 113 VGAM treated between January 2004 and April 2015. After exclusions, 45 patients were included: 33 choroidal and 12 mural types. RESULTS Presenting symptom in the order of frequency: enlarged head circumference, antenatal diagnosis, mild CHF, and PHT at birth. Older patients were diagnosed following trauma, headache, cognitive decline, and incidentally during workup for other diseases. Hydrocephalus due to hydrodynamic disorder was present in 70% of choroidal and 58% of mural types. Only a quarter needed cerebrospinal fluid diversion procedure. Radiological cure was achieved in 82%; the outcome graded on a 5-point scale: 0 (death) to 4 (normal). A total of 66.6% are neurologically and developmentally intact with outcome score 4, 20% had outcome score of 3, and 8.9% had outcome score of 2. There was 4.4% mortality. Dural feeders to VGAM were found either in the initial or during the treatment in 22.2% in the current series. Angiogenesis from pial vessels developed after partial embolization in 17.7% that resolved completely following complete obliteration of VGAM. CONCLUSION Technical and technological advancements in endovascular embolization along with better understanding of clinical, anatomic, and pathophysiological aspects have resulted in significantly improved outcome and prognosis in VGAM. Most patients with proper treatment can now survive and most develop normally following appropriately timed treatment.
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Affiliation(s)
- Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Srinivasan Paramasivam
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Michelle Sorscher
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Walter Molofsky
- Depa-rtment of Neurology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Dan Meila
- Hannover Medical School, Institute of Neuroradiology, Hannover, Germany
| | - Saadi Ghatan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Berenstein A, Toma N, Niimi Y, Paramasivam S. Occlusion of Posterior Fossa Dural Sinuses in Vein of Galen Malformation. AJNR Am J Neuroradiol 2016; 37:1092-8. [PMID: 26797140 DOI: 10.3174/ajnr.a4688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spontaneous or progressive occlusion of the posterior fossa dural sinuses is often observed in patients with vein of Galen malformation, which can affect the clinical course. The aim of this study was to examine the patency of the posterior fossa dural sinuses in patients with vein of Galen malformation and to analyze the clinical and angiographic course of this condition. MATERIALS AND METHODS We retrospectively reviewed 61 consecutive children with vein of Galen malformations. Clinical presentation, management, outcome, and angiographic change were analyzed for the patients with attention paid to all dural sinus occlusions. RESULTS Twenty patients (32.8%) demonstrated spontaneous sinus occlusion, mostly in the sigmoid sinus. This condition was not observed in neonates and was first discovered during infancy or childhood. Progression of sinus occlusion was seen in 10 patients, and the conditions of 6 of them deteriorated in accordance with the progression of sinus occlusion. After total or subtotal obliteration of the malformation by transarterial glue embolization, 13 patients recovered to healthy, 3 patients had only mild developmental delay, and 4 patients remained neurologically disabled. CONCLUSIONS Spontaneous sinus occlusion is not a rare condition and can result in neurologic deterioration in the natural history of untreated vein of Galen malformation. If signs of progressive sinus occlusion are noticed, early arteriovenous shunt reduction or elimination by transarterial glue embolization is expected to prevent permanent brain damage.
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Affiliation(s)
- A Berenstein
- From the Hyman Newman Institute of Neurology and Neurosurgery (A.B., S.P.), Ichan School of Medicine at Mount Sinai Hospital, New York, New York
| | - N Toma
- Department of Neurosurgery (N.T.), Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Y Niimi
- Department of Neuroendovascular Therapy (Y.N.), St. Luke's International Hospital, Tokyo, Japan
| | - S Paramasivam
- From the Hyman Newman Institute of Neurology and Neurosurgery (A.B., S.P.), Ichan School of Medicine at Mount Sinai Hospital, New York, New York
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Abstract
The vein of Galen is the most common type of arteriovenous malformation in the fetus and neonate. Most vein of Galen arteriovenous malformations (VGAMs) are diagnosed in the neonatal period, with the remainder being identified in early childhood, typically via computed tomography scan. The VGAM is found in five different patterns where the vein of Galen and straight sinus extending to the torcula Herophili are dilated. This dilation can lead to significant compression of the posterior fossa structures. Clinically, the infant with this malformation can present with seizures or most commonly, high output cardiac failure. It is important, however, to keep a broad differential diagnosis as more prevalent neonatal conditions arise similarly. These conditions can include developmental delay, cerebral palsy, epilepsy, superior vena cava syndrome, hemangioendothelioma, and other arteriovenous fistulae. Treatment begins with early diagnosis and testing of initial sequelae. This is often accomplished in consultation with different pediatric subspecialists, particularly neurologists and cardiologists. The mainstay of therapy is with neurosurgical intervention. Although the mortality of a fetus or neonate with VGAM is very high, prognosis is dependent on the size of the malformation, age at diagnosis, and successful neurosurgical outcome.
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Deloison B, Chalouhi GE, Sonigo P, Zerah M, Millischer AE, Dumez Y, Brunelle F, Ville Y, Salomon LJ. Hidden mortality of prenatally diagnosed vein of Galen aneurysmal malformation: retrospective study and review of the literature. Ultrasound Obstet Gynecol 2012; 40:652-658. [PMID: 22605540 DOI: 10.1002/uog.11188] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the prognosis of prenatally diagnosed vein of Galen aneurysmal malformation (VGAM) in a large cohort with this condition and to review the literature on prenatally diagnosed VGAM. METHODS This was a retrospective study of all cases of prenatally diagnosed VGAM managed in our referral center during a 12-year period. VGAM was categorized as being either isolated or associated with any other abnormality, based on fetal ultrasound and magnetic resonance imaging findings. Poor outcomes comprised termination of pregnancy with confirmation of antenatal findings, perinatal death and severe cardiac and/or neurological impairment in survivors. The literature was also reviewed for similar cases. RESULTS Twenty-one cases of prenatally diagnosed VGAM were managed in our center. Four (19.0%) cases were isolated and 17 (81.0%) were associated with other anomalies. There were nine terminations (42.9%) and six neonatal deaths (28.6%). Six children (28.6%) were still alive at last follow-up, of whom three had abnormal neurological development. VGAM associated with other anomalies was strongly associated with a poor outcome compared with isolated forms (P < 0.0001). One hundred and nine cases from the literature were also reviewed. CONCLUSION Fetuses with prenatally diagnosed VGAM have unexpectedly poor outcomes in the presence of cardiac or cerebral anomalies, while those with strictly isolated VGAM tend to have more favorable outcomes. Our literature review corroborates these findings.
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Affiliation(s)
- B Deloison
- Department of Obstetrics and Fetal Medicine and SFAPE (Société Française d'Amélioration des Pratiques Echographique), Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants, Paris, France
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Kong JCW, Cheng KM, Cheung YL, Chan CM. Transarterial embolisation with Guglielmi detachable coils in an infant with a vein of Galen aneurysmal malformation. Hong Kong Med J 2012; 18:435-438. [PMID: 23018073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Vein of Galen aneurysmal malformation is a rare entity in the paediatric population. However, it is being recognised with increasing frequency due to better diagnostic techniques. Neonates usually present with congestive heart failure, while in older infants and children it tends to manifest with seizures, hydrocephalus, intracerebral or subarachnoid haemorrhages. We present a case of ruptured vein of Galen aneurysmal malformation in a 3-month-old baby boy treated by transarterial embolisation using Guglielmi detachable coils.
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Affiliation(s)
- James C W Kong
- Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
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Szajner M, Pyra K, Poluha P, Przyszlak M, Sojka M, Szczerbo-Trojanowska M. [Endovascular treatment of vein of galen malformation with coils and onyx--case report]. Przegl Lek 2012; 69:307-310. [PMID: 23276021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vein of galen malformation (VOGM) is a very rare disease which affects blood vessels of the brain. In general population the incidence is estimated at 1%. Treatment of choice is transluminal embolization. We present the case of five-month-old child with low degree heart failure, hydrocephalus and significantly delayed psychomotor development. MR examination reveals a vein of Galen malformations, wall type (type I according to Yasargil) 6 cm in diameter, with venous drainage to the sinus rectus. The enlarged vein filled with thrombus. It causes brain stem compression. Angiography shows one feeder leading to the VOGM, from right posterior brain artery. Lesion was treated with two embolic materials: 5 coils and 2 ml of ONYX. Angiography confirmed total exclusion of the fistula and the circulation in the vein of Galen. One of the most important elements of treatment is to perform a proper diagnosis and evaluation of lesions morphology. With proper technique, high skills and proper equipment, intravascular embolization of vein of Galen malformation is an effective treatment.
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Affiliation(s)
- Maciej Szajner
- Zakład Radiologii Zabiegowej i Neuroradiologii, Uniwersytet Medyczny w Lublinie.
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Chen MY, Liu HM, Weng WC, Peng SF, Wu ET, Chiu SN. Neonate with severe heart failure related to vein of Galen malformation. Pediatr Neonatol 2010; 51:245-248. [PMID: 20713291 DOI: 10.1016/s1875-9572(10)60047-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/13/2009] [Accepted: 09/04/2009] [Indexed: 11/19/2022] Open
Abstract
We report a full-term female neonate who presented with respiratory distress and severe heart failure soon after birth. Heart failure secondary to perinatal infection was initially suspected. Subsequent echocardiography revealed aortic runoff, which led to consideration of an intracranial vascular abnormality. Ultrasound and magnetic resonance imaging of the brain confirmed a diagnosis of vein of Galen aneurismal malformation (VGAM). Endovascular coil embolization of the vascular anomaly was performed, resulting in improvement of heart failure. VGAM should be considered in the differential diagnosis of neonatal congestive heart failure with a structurally normal heart. Urgent endovascular embolization and aggressive medical treatment of heart failure improve prognosis in neonatal VGAM.
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Affiliation(s)
- Meng-Yu Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hon-Man Liu
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shinn-Forng Peng
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
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Adaev AR, Iakovlev SB, Khukhlaeva EA, Pilipenko IV. [Vein of Galen malformations in children]. Zh Vopr Neirokhir Im N N Burdenko 2009:56-60. [PMID: 20143614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The literature review deals with historical stages of understanding of vein of Galen AVM pathogenesis in children up to state-of-art considerations. The authors analyzed existing classifications, clinical presentation, variants of natural course, problems of diagnostics and management of these patients. Causes of complications and possible ways for their prevention are also discussed.
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Kar P, Rath GP, Prabhakar H, Ali Z. Tracheal deviation may be a normal anatomical variant in children. Anaesth Intensive Care 2009; 37:144-145. [PMID: 19157372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Germanwala AV, Vora NA, Thomas AJ, Jovin T, Gologorsky Y, Horowitz MB. Ethylenevinylalcohol copolymer (Onyx-18) used in endovascular treatment of vein of Galen malformation. Childs Nerv Syst 2008; 24:135-8. [PMID: 17701187 DOI: 10.1007/s00381-007-0425-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 04/25/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vein of Galen malformations (VGM) are rare congenital arteriovenous fistulas that usually present with heart failure in the neonate. Endovascular treatment options in the past have utilized coils, balloons, and acrylics. CASE REPORT We present, for the first time in the literature, a case of an infant with VGM treated initially with staged coil embolizations followed 1 year later by the transarterial and transvenous catheter based injection of Onyx-18 (ethylenevinylalcohol copolymer) in a single treatment session. The fistula was eliminated, and the infant's cardiopulmonary symptoms were improved.
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Affiliation(s)
- Anand V Germanwala
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Filippi L, Pezzati M, Poggi C, Pasquini E. Vein of Galen aneurysmal malformation and galactosemia in a neonate: a previously unreported association. Paediatr Anaesth 2007; 17:1221-3. [PMID: 17986048 DOI: 10.1111/j.1460-9592.2007.02339.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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