Related Experiment Videos
Therapeutic alternatives for vein of Galen vascular malformations
1Department of Radiology, University of California School of Medicine, Los Angeles.
Insights
This study evaluated endovascular embolization for vein of Galen malformations in 28 children. Embolization improved clinical status in most patients, but risks and mortality associated with the procedure were observed.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Vascular Malformations
Background:
- Vein of Galen malformations (VGAM) are rare congenital vascular anomalies.
- VGAM can lead to severe complications including heart failure, seizures, and hemorrhage.
- Early diagnosis and treatment are crucial for improving outcomes in affected children.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular embolization for treating vein of Galen malformations in pediatric patients.
- To analyze patient demographics, clinical presentations, and treatment outcomes.
- To assess the procedural risks and mortality associated with different embolization techniques.
Main Methods:
- Retrospective analysis of 28 children treated for VGAM between 1986 and 1990.
- Classification of malformations using the Yaşargil system.
- Interventional procedures included combined transfemoral, transarterial, transvenous embolization, and transtorcular embolization.
- Surgical clipping was used in select cases.
Main Results:
- Fifteen patients (53.6%) presented with severe congestive heart failure.
- Complete anatomical occlusion was achieved in 13 patients (46.4%).
- Immediate clinical improvement was observed in 82.1% of patients, with a good long-term outcome in 60.7%.
Conclusions:
- Endovascular embolization is an effective treatment for vein of Galen malformations, leading to significant clinical improvement.
- While effective, the procedure carries risks, including mortality, particularly with the transtorcular approach.
- Careful patient selection and procedural technique are essential for optimizing outcomes in pediatric VGAM treatment.
Abstract:
From September, 1986, to March, 1990, the authors treated 28 children harboring a vein of Galen vascular malformation. Eleven (39.3%) of the patients were neonates, 13 (46.4%) were 1 to 2 years old, and four (14.3%) were more than 2 years old. Fifteen patients (53.6%) presented with severe congestive heart failure, six (21.4%) had seizures, four (14.3%) had hydrocephalus, and three (10.7%) presented with intraventricular hemorrhage. Based on the Yaşargil classification of malformations, 10 lesions (35.7%) were Type I, seven (25%) were Type II, eight (28.6%) were Type III, and three (10.7%) were Type IV. In 11 patients (39.3%), a combined transfemoral, transarterial, and transvenous embolization of the vein of Galen malformation was performed. A pure transtorcular approach was utilized in eight patients (28.6%), and postembolization surgical clipping of arterial feeders was performed in two cases with intractable congestive heart failure. Complete anatomical occlusion of the galenic malformation was achieved in 13 patients (46.4%). An immediate postembolization improvement in the patient's clinical status was obtained in 23 (82.1%) of 28 patients and a good long-term clinical outcome was seen in 17 patients (60.7%). Five deaths (17.9%) occurred in this series of 28 patients; three (10.7%) were related to a transtorcular embolization and two (7.1%) to the unchanged natural history of the disease.