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Interventional neuroradiological management of vein of Galen malformations in the neonate
S F Ciricillo1, M S Edwards, K G Schmidt
1Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Insights
New interventional neuroradiological techniques significantly improved survival rates for neonates with vein of Galen malformations and congestive heart failure. This approach offers a less invasive alternative to craniotomy for treating this critical condition.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Neonatal Cardiology
Background:
- Vein of Galen malformations (VOGM) frequently present with severe congestive heart failure in neonates.
- Historical treatment via craniotomy and clipping of feeding vessels had a prohibitive mortality rate.
- Advancements in treatment strategies are crucial for improving outcomes in affected neonates.
Purpose of the Study:
- To evaluate the efficacy of combined arterial and venous interventional neuroradiological techniques in treating neonates with VOGM.
- To compare outcomes between historical surgical treatment and modern endovascular embolization.
- To assess the role of advanced ultrasound techniques in managing VOGM.
Main Methods:
- Retrospective analysis of 14 neonates with VOGM and congestive heart failure treated between 1978 and present.
- Comparison of outcomes between 5 infants treated with craniotomy before 1983 and 8 infants treated with interventional neuroradiology since 1983.
- Utilization of 2D echocardiography, color Doppler, and pulsed Doppler ultrasound for pre- and post-embolization flow assessment.
- Staged transluminal embolic procedures guided by diagnostic imaging and clinical status.
Main Results:
- All 5 infants treated with craniotomy before 1983 died perioperatively.
- 6 out of 8 infants treated with interventional neuroradiology since 1983 survived.
- Ultrasound modalities effectively monitored blood flow changes within the malformation post-embolization.
- Interventional techniques allowed for staged treatment tailored to individual patient needs.
Conclusions:
- Combined arterial and venous interventional neuroradiological techniques represent a significant advancement in VOGM management.
- This endovascular approach offers improved survival rates compared to historical surgical interventions.
- Non-invasive ultrasound imaging is vital for guiding and evaluating the success of embolization therapy in neonates with VOGM.
Abstract:
Since 1978, the authors have seen 14 neonates with vein of Galen malformations who were born with severe congestive heart failure. The 5 infants treated before 1983 underwent craniotomy and clipping of feeding vessels; all died in the perioperative period. Since 1983, 8 neonates have been treated with combined arterial and venous interventional neuroradiological techniques; 6 infants survived. Two-dimensional echocardiography, color Doppler flow imaging, and pulsed Doppler ultrasound were used to assess blood flow within the malformation before and after staged transluminal embolic procedures were performed. The results of the diagnostic studies and the clinical status of the infants were used to evaluate the success of embolic therapy and the need for further neuroradiological intervention.