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Parodi C, Aluffi Valletti M, Tortora D, Buratti S, Mallamaci M, Tuo G, Pistorio A, Moscatelli A, Rossi A, Severino M. Vein of Galen aneurysmal malformation: does size affect outcome? Neuroradiology 2024; 66:1031-1042. [PMID: 38607438 PMCID: PMC11133167 DOI: 10.1007/s00234-024-03347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To validate a semiautomated method for segmenting vein of Galen aneurysmal malformations (VGAM) and to assess the relationship between VGAM volume and other angioarchitectural features, cardiological findings, and outcomes. METHODS In this retrospective study, we selected all subjects with VGAM admitted to the Gaslini Children's Hospital between 2009 and 2022. Clinical data were retrieved from electronic charts. We compared 3D-Slicer segmented VGAM volumes obtained by two independent observers using phase-contrast MR venography to those obtained with manual measurements performed on T2-weighted images. The relationship between VGAM volumes and clinical and neuroimaging features was then explored. RESULTS Forty-three subjects with VGAM (22 males, mean age 6.56 days) were included in the study. Manual and semiautomated VGAM volumes were well correlated for both readers (r = 0.86 and 0.82, respectively). Regarding reproducibility, the inter-rater interclass correlation coefficients were 0.885 for the manual method and 0.992 for the semiautomated method (p < 0.001). The standard error for repeated measures was lower for the semiautomated method (0.04 versus 0.40 of manual method). Higher VGAM volume was associated with superior sagittal sinus narrowing, jugular bulb stenosis, and aqueductal stenosis (p < 0.05). A weak correlation was found between VGAM volume and straight sinus dilatation (r = 0.331) and superior sagittal sinus index (r = - 0.325). No significant associations were found with cardiac findings, post-embolization complications, and outcome (p > 0.05). CONCLUSIONS Semiautomated VGAM volumetry is feasible and reliable with improved reproducibility compared to the manual method. VGAM volume is not a prognostic factor for clinical outcome, but it is related to other venous findings with potential hemodynamic effects.
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Affiliation(s)
- Costanza Parodi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit and Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marisa Mallamaci
- Neonatal and Pediatric Intensive Care Unit and Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Tuo
- Pediatric Cardiology and Cardiac Surgery Unit, Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angela Pistorio
- Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit and Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
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Bursać D, Stipanović J, Partl JZ, Lučić D, Hadžić D, Bošnjak DC, Duić Ž. Literature review and case report: Rare case of successful prenatal detection of Vein of Galen Malformation (VGAM). Eur J Obstet Gynecol Reprod Biol X 2024; 22:100306. [PMID: 38846579 PMCID: PMC11153931 DOI: 10.1016/j.eurox.2024.100306] [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: 02/01/2024] [Accepted: 03/25/2024] [Indexed: 06/09/2024] Open
Abstract
Vein of Galen aneurysmal malformation (VGAM) is a rare vascular anomaly originating during embryonic development, specifically between the 6th and 11th weeks of gestation. This malformation results from abnormal arteriovenous connections between primitive choroidal arteries and the median prosencephalic vein (MPV) of Markowski. Typically, the MPV regresses by the 11th week, but in VGAM, this regression is hindered, leading to persistent abnormal flow and the formation of arteriovenous shunts. We present a case of successful prenatal detection, as well as a comprehensive literature review that summarizes current knowledge, emphasizes the importance of prenatal detection, detailed imaging techniques, understanding clinical presentations, and outlines treatment options. Prenatal detection, crucial for early intervention, has become feasible through ultrasonography and MRI. Fetal MRI has emerged as the gold standard, offering detailed insights into arterial feeders, nidus presence, fistula position, venous drainage, and potential complications. The clinical presentation of VGAM varies with age, and neonates diagnosed in utero may exhibit signs of high-output cardiac failure. Early detection is critical for timely intervention, as untreated VGAMs often result in high mortality rates. Prognosis depends on the severity of heart failure, the number of arteriovenous shunts, and the presence of accompanying fetal abnormalities. Various imaging modalities, including CT angiography and digital subtraction angiography (DSA), aid in the assessment and treatment of VGAM. DSA remains the gold standard for evaluating angioarchitecture and guiding endovascular interventions. The optimal treatment for VGAM is transarterial embolization, offering significant improvements in prognosis. Surgical interventions are limited due to high morbidity and mortality. Management decisions should consider the balance between minimizing neurological damage and achieving maximum embolization effectiveness.
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Affiliation(s)
- Danijel Bursać
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
- University of North, University Center Varaždin, Croatia
- School of Medicine, University of Zagreb, Croatia
| | - Jasminka Stipanović
- Department of Neonatology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Croatia
| | - Jasenka Zmijanac Partl
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Croatia
| | - Dejana Lučić
- Polyclinic Vaš pregled, Zagreb, Croatia
- School of Medicine, University of Zagreb, Croatia
| | - Daria Hadžić
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
- School of Medicine, University of Zagreb, Croatia
| | - Diana Culej Bošnjak
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Croatia
| | - Željko Duić
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
- School of Medicine, University of Zagreb, Croatia
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Bogovski S, Sirakova K, Sirakov S. Spontaneous thrombosis of type II vein of Galen aneurysmal malformation: a case report. Folia Med (Plovdiv) 2024; 66:269-276. [PMID: 38690824 DOI: 10.3897/folmed.66.e113248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/10/2023] [Indexed: 05/03/2024] Open
Abstract
Vein of Galen malformations (VGAMs) are rare and complex congenital brain vascular anomalies that pose significant diagnostic and treatment challenges. The natural history of this type of vascular anomaly is very poor, with many patients succumbing to complications such as congestive heart failure, hydrocephalus, and brain parenchymal injury. Although the clinical course of most VGAMs was considered unfortunate, with meticulous imaging, a group of lesions with a more placid presentation and course can be identified.
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Kaplan JS, Dardanelli EP, Requejo F, Mackintosh C, Lipsich JE. Use of greyscale and Doppler ultrasound in initial evaluation and follow-up of neurovascular malformations in children. Pediatr Radiol 2024; 54:347-356. [PMID: 38191809 DOI: 10.1007/s00247-023-05846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
Pediatric intracranial arteriovenous shunts are rare vascular malformations that can be diagnosed prenatally or postnatally, as an incidental finding or due to complications. We propose a review of cerebral vascular malformations in newborns and infants with special emphasis on neurosonography and Doppler ultrasound as the first diagnostic method. Sonography can thus contribute in the planning of further studies that are always necessary, and in post-therapy follow-up.
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Affiliation(s)
- Julio S Kaplan
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina.
| | - Esteban P Dardanelli
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
| | - Flavio Requejo
- Department of Neuroradiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
| | - Cecilia Mackintosh
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
| | - José E Lipsich
- Department of Radiology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881 (C 1425 AAM), Buenos Aires, Argentina
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Savage C, Hale AT, Parr MS, Hedaya A, Saccomano BW, Tsemo GB, Hafeez MU, Tanweer O, Kan P, Solomon LJ, Meila D, Dirks PB, Blount JP, Johnston JM, Rocque BG, Rozzelle CJ, Bhatia K, Muthusami P, Krings T, Jones J. Outcomes of endovascular embolization for Vein of Galen malformations: An individual participant data meta-analysis. Front Pediatr 2022; 10:976060. [PMID: 36245731 PMCID: PMC9561813 DOI: 10.3389/fped.2022.976060] [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: 06/23/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Understanding outcomes after Vein of Galen malformation (VOGM) embolization has been limited by small sample size in reported series and predominantly single center studies. To address these limitations, we perform an individual-participant meta-analysis (IPMA) to identify risk factors associated with all-cause mortality and clinical outcome after VOGM endovascular embolization. Methods We performed a systematic review and IPMA of VOGM endovascular outcomes according to PRISMA guidelines. Individual patient characteristics including demographic, intra/post-operative adverse events, treatment efficacy (partial or complete occlusion), and clinical outcome were collected. Mixed-effects logistic regression with random effects modeling and Bonferroni correction was used (p ≤ 0.003 threshold for statistical significance). The primary and secondary outcomes were all-cause mortality and poor clinical outcome (moderate/severe developmental delay or permanent disabling injury), respectively. Data are expressed as (mean ± standard deviation (SD)) or (odds ratio (OR), 95% confidence interval (CI), I 2, p-value). Results Thirty-five studies totaling 307 participants quantifying outcomes after endovascular embolization for VOGM were included. Follow up time was 42 (±57) months. Our analysis contained 42% neonates (<1 month) at first embolization, 45% infants (1 month ≤2 years), and 13% children (>2 years). Complete occlusion was reported in 48% of participants. Overall all-cause mortality was 16%. Overall, good clinical outcome was achieved in 68% of participants. First embolization as a neonate [OR = 6.93; 95% CI (1.99-24.08); I 2 < 0.01; p < 0.001] and incomplete embolization [OR = 10.87; 95% CI (1.86-63.55); I 2 < 0.01; p < 0.001] were associated with mortality. First embolization as a neonate [OR = 3.24; 95% CI (1.47-7.15); I 2 < 0.01; p < 0.001], incomplete embolization [OR = 5.26; 95% CI (2.06-13.43); I 2 < 0.01; p < 0.001], and heart failure at presentation [OR = 3.10; 95% CI (1.03-9.33); I 2 < 0.01; p = 0.002] were associated with poor clinical outcomes. Sex, angioarchitecture of lesion, embolization approach (transvenous vs. transarterial), and single or multistage embolization were not associated with mortality or clinical outcome. Conclusions We identify incomplete VOGM embolization independently associated with mortality and poor clinical outcome. While this study provides the highest level of evidence for VOGM embolization to date, prospective multicenter studies are needed to understand the optimal treatment strategies, outcomes, and natural history after VOGM embolization.
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Affiliation(s)
- Cody Savage
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrew T. Hale
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew S. Parr
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alexander Hedaya
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Benjamin W. Saccomano
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Georges Bouobda Tsemo
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Muhammad U. Hafeez
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston TX, United States
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Laurent J. Solomon
- Department of Obstetrics and Fetal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants, Paris, France
| | - Dan Meila
- Department of Interventional Radiology, Helois Klinikum Krefeld, Johanna-Etienne Hospital Neuss, Neuss, Germany
| | - Peter B. Dirks
- Division of Pediatric Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jeffrey P. Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James M. Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Brandon G. Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Curtis J. Rozzelle
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kartik Bhatia
- Department of Medical Imaging, Sydney Children’s Hospital Network, Westmead, NSW, Australia
| | - Prakash Muthusami
- Division of Interventional Radiology, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada
| | - Timo Krings
- Division of Interventional Radiology, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Jones
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
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Subramanian A, Jayranganath M, Bharath A, Barthur A, Sastry UK, M. Moorman A. Congenital systemic arteriovenous fistulas: Interventional strategies and embryological perspectives. Ann Pediatr Cardiol 2022; 15:138-146. [PMID: 36246751 PMCID: PMC9564402 DOI: 10.4103/apc.apc_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/05/2021] [Accepted: 10/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Data on congenital systemic arteriovenous fistulas are largely based on individual case reports. A true systemic arteriovenous fistula needs to be differentiated from other vascular malformations like capillary or venous hemangiomas, which are far more common. Objectives: We sought to identify the varied symptoms, diagnostic challenges, describe interventional treatment options, and postulate an embryological basis for this uncommonly described entity. Methods: This is a descriptive study of a cohort of systemic arteriovenous fistulas seen in the department of pediatric cardiology at a tertiary cardiac institute from 2010 to 2020, with prospective medium-term follow-up. A total of seven cases were identified. The diagnosis was confirmed by computed tomographic imaging, magnetic resonance angiography, or conventional angiography. Results: All were successfully closed using duct occluders or embolization coils with no recurrence in six cases over a median duration of follow-up of 48 months (interquartile range: 16; 36–52 months). Four of the seven cases underwent follow-up imaging using echocardiography or ultrasound. Conclusion: The incidence of congenital systemic arteriovenous fistulas is low and accounted for 0.009% of pediatric outpatients seen over 10 years at our institute. The spectrum of clinical presentation varies from an innocuous swelling or a pulsating mass to frank heart failure. Strong clinical suspicion and advanced imaging modalities have helped identify some hitherto undescribed connections. Large malformations with multiple communications may persist or recur despite transcatheter closure.
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Mishra A, Kumar A, Mathur A, Kumar V, Sreen A. Coil assisted glue embolization to improve safety and accuracy in endovascular management of Vein of Galen patients. Clin Neurol Neurosurg 2021; 205:106652. [PMID: 33957409 DOI: 10.1016/j.clineuro.2021.106652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/28/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vein of Galen malformation (VOGM) patients present in neonatal age with cardiac failure or significant neurologic consequences. The most established method of treatment has been transarterial embolization with high concentration glue (N-Butyl Cyano Acrylate) which may be difficult to control due to very high flow rates and may migrate to the venous side with undesirable consequences. We describe our experience in four patients in whom initial coil placement in prominent feeding arteries helped inflow reduction thereby facilitating controlled glue injection with a good result and no incidence of non-target embolization. MATERIALS AND METHODS Four neonates who had presented during the last three years with cardiac failure were included in the study. Prominent feeders identified on imaging or DSA were treated with transarterial helical coil placement in the terminal segment just before the VOGM sac followed by controlled glue injection. The outcome was assessed by detailed clinical and imaging follow-up. RESULTS A total of 10 most prominent feeders were embolized in four patients. Complete embolization of the VOGM was achieved in two patients in a single session. One patient with residual small feeders showed subsequent thrombosis of these feeders, possibly secondary to flow reduction in the sac. One patient still shows thin residual feeders but good clinical improvement and is being planned for follow-up and a second session at one year of age. No complications were observed. All patients showed immediate improvement in cardiac failure and good neurological development on follow-up. On imaging, the VOGM sac regressed completely (3 patients) or significantly in size (1 patient). CONCLUSION Planned coil placement in the terminal part of prominent feeding arteries reduced the flow and provided lattice on which glue deposits in a controlled manner without any incidence of non-target embolization in our study. This relatively less described technique increases the safety and accuracy of the endovascular treatment in VOGM patients.
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Affiliation(s)
- Atul Mishra
- Army Hospital (Referral & Research), Delhi Cantt, New Delhi 110010, India
| | - Ashutosh Kumar
- Army Hospital (Referral & Research), Delhi Cantt, New Delhi 110010, India
| | - Ankit Mathur
- Army Hospital (Referral & Research), Delhi Cantt, New Delhi 110010, India
| | - Vivek Kumar
- Army Hospital (Referral & Research), Delhi Cantt, New Delhi 110010, India
| | - Amit Sreen
- Army Hospital (Referral & Research), Delhi Cantt, New Delhi 110010, India.
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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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Deepti S, Juneja R, Devarajan Sebastian LJ. Endovascular management of vein of Galen aneurysmal malformation in a neonate. Ann Pediatr Cardiol 2018; 11:304-307. [PMID: 30271022 PMCID: PMC6146857 DOI: 10.4103/apc.apc_33_18] [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] [Indexed: 11/18/2022] Open
Abstract
A term baby presented on the 7th day of life in cardiogenic shock due to vein of Galen aneurysmal malformation. A successful embolization of the malformation was performed through transarterial route on day 12 of life after a period of initial stabilization.
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Affiliation(s)
- Siddharthan Deepti
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Leve Joseph Devarajan Sebastian
- Department of Neuroimaging and Interventional Neuroradiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
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Hosmann A, El-Garci A, Gatterbauer B, Bavinzski G, Knosp E, Gruber A. Multimodality Management of Vein of Galen Malformations-An Institutional Experience. World Neurosurg 2018; 112:e837-e847. [PMID: 29408495 DOI: 10.1016/j.wneu.2018.01.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The vein of Galen aneurysmal malformation (VGM) is a rare intracranial arteriovenous fistula with a dramatic manifestation during infancy and 100% mortality without treatment. Therapeutic strategies for VGMs have changed over time as a result of advances in endovascular techniques. We present our experience and multimodality approach within the last 4 decades. METHODS A retrospective analysis and angiographic review were performed of patients with VGM between 1975 and 2016 at our institution. RESULTS Eighteen consecutive patients were identified, including 10 with choroidal and 8 with mural VGMs. In 37 endovascular interventions, a transarterial approach was mostly performed (82.8%). One patient was initially treated surgically and received 2 Gamma Knife treatments after multiple embolizations. The preferred embolization agent was histoacryl for choroidal VGMs and a combination of coils and histoacryl for mural VGMs. Total occlusion was achieved in 87.5% of mural VGMs and 11.1% of choroidal VGMs. Cerebral hemorrhages and infarction occurred only in patients younger than 1 month. At a median follow-up interval of 4.6 years, good outcome was achieved in 53.8% and poor outcome in 46.2%, with an overall mortality of 16.7%. Poor outcome was significantly associated with choroidal-type VGMs, age <1 month at first embolization, and incomplete occlusion. CONCLUSIONS Endovascular embolization using a transarterial approach is the therapy of choice. Gamma Knife radiosurgery can be considered as second-line therapy in a multimodal approach. Whereas treatment within the first month of life is associated with the highest mortality and complications, we did not detect any severe adverse events thereafter.
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Ahmed El-Garci
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
| | - Andreas Gruber
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Kepler Universitätsklinikum, Johannes Kepler University Linz, Linz, Austria
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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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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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Lasjaunias P, Magufis G, Goulao A, Piske R, Suthipongchai S, Rodesch R, Alvarez H. Anatomoclinical Aspects of Dural Arteriovenous Shunts in Children. Interv Neuroradiol 2016; 2:179-91. [DOI: 10.1177/159101999600200303] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1996] [Accepted: 07/25/1996] [Indexed: 11/17/2022] Open
Abstract
We review 29 children (presenting between 1985–1996) with dural arteriovenous shunts. By analysing the anatomical features from axial and angiographic imaging and examining the clinical history and pathophysiological characteristics, we hypothesize that different diseases can be distinguished and divided into three groups: dural sinus malformation (DSM), infantile type of dural arteriovenous shunts (IDAVS) and adult type of dural arteriovenous shunts (ADAVS). It was helpful to classify these diseases when assessing the treatment options and long-term prognosis. Our group of 29 children comprised 19 DSM, 7 IDAVS, 3 ADAVS. A slight male preponderance was noted in the DSM group. The range of symptoms encountered included mild cardiac failure and coagulopathies, macro-crania, developmental delay, mental retardation, seizures and focal neurological deficits (in the neonates and early infancy age group) with or without haemorrhagic venous infarctions secondary to venous outlet restriction. We found all types of lesion in the neonatal age group, but in general the different types of lesion correspond to the paediatric subgroups with DSM occurring in the neonatal age group, IDAVS in infancy and ADAVS in children. DSMs are revealed in the first few months of live and the prognosis is good if the torcular is not involved. Two types can be seen: 1) DSM involving the posterior sinus with or without the confluens sinusum, with giant dural lakes and slow flow mural AV shunting. Spontaneous thrombosis may further restrict cerebral venous drainage and subsequently lead to intraparenchymatous haemorrhagic infarction. 2) DSM involving the jugular bulb with otherwise normal sinuses but associated with a high flow sigmoïd sinus AVF. The prognosis is excellent with embolisation treament. IDAVS are high flow and low pressure. The sinuses are large and patent with no lakes. Clinical onset is seen in the first few years of life and the shunts are initially well tolerated. Progressive symptoms (symptoms of raised ICP and venous ischaemia) develop at a later age and initially respond to partial embolisation. The long term prognosis is poor with neurological deterioration in early adulthood. ADAVS present in all age groups and almost all of them are located in the cavernous venous plexus. Post embolisation outcome is excellent.
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Affiliation(s)
| | | | - A. Goulao
- Neuroradiologie, Hospital Garcia de Orta; Almada, Portugal
| | - R. Piske
- Med Imagem, Hospital Beneficencia Portuguesa, Paraiso; Sao Paulo SP Brazil
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Iizuka Y, Maehara T, Katayama H, Sato K, Kugimiya T, Yamashiro Y. Endovascular Treatment of Vein of Galen Aneurysmal Malformations. Interv Neuroradiol 2016; 4 Suppl 1:109-12. [DOI: 10.1177/15910199980040s123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/1998] [Accepted: 08/25/1998] [Indexed: 11/16/2022] Open
Abstract
We report two cases of vein of Galen aneurysmal dilatation (VGAD) and four cases of vein of Galen aneurysmal malformation (VGAM) with special reference to clinical features and therapeutic indications of endovascular treatment. A case with VGAD was treated by radiosurgery in 1985 with no amelioration to the patient, A case of choroidal type VGAM underwent an operation in 1987, but died of massive hemorrhage 2 years later. The other case of VGAD has been followed-up conservatively. The remaining cases of VGAM (two choroidal type and one mural type) were treated by endovascular treatment. The two cases of choroidal type were successfully embolized but died of systemic complications, and the only case of mural type was cured.
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Affiliation(s)
| | | | | | - K. Sato
- Department of Neurosurgery, Juntendo University, School of Medicine; Tokyo
| | - T. Kugimiya
- Department of Anesthesiology, Juntendo University, School of Medicine; Tokyo
| | - Y. Yamashiro
- Department of Pediatrics, Juntendo University, School of Medicine; Tokyo
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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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Oshiro T, Nakayama O, Ohba C, Ohashi Y, Kawakubo J, Nagamine T, Komiyama M. Transumbilical arterial embolization of a large dural arteriovenous fistula in a low-birth-weight neonate with congestive heart failure. Childs Nerv Syst 2016; 32:723-6. [PMID: 26351075 DOI: 10.1007/s00381-015-2906-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to report transumbilical arterial embolization of a large dural arteriovenous fistula (AVF) in a low-birth-weight neonate with congestive heart failure (CHF). CASE PRESENTATION A female neonate was delivered by cesarean section at 31 weeks of gestation. Her birth weight was 1538 g and Apgar scores were 6 at both 1 and 5 min. Because of dyspnea and retracted respiration immediately after birth, she required mechanical ventilation. Ultrasound revealed right cardiac overload and a large cystic mass at the posterior brain. Magnetic resonance imaging on day 1 showed a large dural AVF (dural sinus malformation with arteriovenous (AV) shunts) at the torcular herophili. Umbilical artery and vein catheterization were performed on the same day for neurointervention. CHF prompted emergency embolization on day 8. The transfemoral arterial route could not be used because of its small size and compromised femoral artery blood flow. Transumbilical arterial embolization shrank the AV shunts markedly, resulting in clinical improvement, thus requiring no further intervention. Follow-up angiography at 4 months confirmed no residual AVF. Her growth and development were normal at the last follow-up at age 4 years. CONCLUSION This patient apparently was the lowest birth weight neonate with a large AVF successfully treated by embolization, which is usually performed through the transfemoral arterial route. The transumbilical arterial route is an alternative for neonates with birth weight <2000 g and very small femoral arteries.
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Affiliation(s)
- Tatsuo Oshiro
- Department of Pediatric Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Okitaka Nakayama
- Department of Pediatric Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Chiaki Ohba
- Department of Pediatric Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Yoko Ohashi
- Department of Obstetrics and Gynecology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Junichi Kawakubo
- Department of Neurosurgery, Sugioka Memorial Hospital, Fukuoka, Japan
| | - Tomoaki Nagamine
- Department of Neurosurgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Masaki Komiyama
- Department of Neuro-Intervention, Osaka City General Hospital, 2-13-22, Miyakojima-Hondori, Miyakojima, Osaka, 534-0021, Japan.
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Spinal arteriovenous metameric syndrome in a neonate presenting with congestive heart failure: case report. Childs Nerv Syst 2014; 30:1607-11. [PMID: 24845229 DOI: 10.1007/s00381-014-2439-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal arteriovenous metameric syndrome (SAMS) is a combination of more than two separate vascular malformations in the same embryonic metameres. This syndrome, also known as Cobb syndrome, is rare, especially in the neonate. CASE DESCRIPTION A neonatal girl with a birthmark in the occipital and posterior nuchal regions presented with severe heart failure on the day of birth. The large arteriovenous fistulas in the left hypoglossal canal and in the posterior nuchal region were embolized with detachable coils on the postnatal days 5 and 18, which improved heart failure markedly. The associated intramuscular arteriovenous malformation in the posterior neck was left untreated because large arteriovenous fistulas had been occluded. She grew up without any neurological deficits and developed with normal milestones until the latest follow-up of 8 years old. CONCLUSION To our knowledge, this is the first case with SAMS in a neonate presenting with congestive heart failure. Presence of a birthmark in a neonate presenting with congestive heart failure may suggest the possible underlying high-flow vascular malformations in the same metamere.
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18
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Toma AK, Davagnanam I, Ganesan V, Brew S. Cerebral Arteriovenous Shunts in Children. Neuroimaging Clin N Am 2013; 23:757-70. [DOI: 10.1016/j.nic.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gupta VB, Choudhary H, Rastogi H, Singh VP. Intracranial arteriovenous malformation in an infant—vein of Galen malformation. APOLLO MEDICINE 2011. [DOI: 10.1016/s0976-0016(11)60014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Neurosurgical vascular malformations in children under 1 year of age. Childs Nerv Syst 2010; 26:1381-94. [PMID: 20658296 DOI: 10.1007/s00381-010-1223-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aims to analyze the clinical and radiological findings, timing and type of treatment, and outcome in children under 1 year of age that presented with neurosurgical vascular malformations. METHODS A retrospective review of 23 children under 1 year of age with neurosurgical vascular malformations was performed at a single institution between 1999 and 2009. RESULTS The lesions found in this age group were: 10 vein of Galen aneurysmal malformations (VGAMs), 5 arteriovenous malformations (AVM), 2 pial arteriovenous fistulas (AVF; 1 in the brain and 1 in the spinal cord), 2 cavernous malformations, 2 dural sinus malformations (DSMs) in the posterior fossa with negative angiography which after surgery turned out to be embryonal malformations of dural sinuses, 1 sacular aneurysm, and 1 dural arteriovenous fistula (DAVF) that drained toward the vein of Galen. Of the 10 patients with VGAM, 8 presented choroidal type and 2 mural type. Two patients with choroidal VGAM were born in dramatically severe clinical condition; therefore, we decided to withhold aggressive treatment, and they died within 48 h after birth. The other eight patients with choroidal VGAM received endovascular treatment between 1 and 3 staged embolizations. In four of them, total occlusion was achieved and subtotal and partial in the others. One patient had complications and evolved with severe developmental delay. Another patient with partial occlusion died, and another patient with previous developmental delay stopped treatment because of parental decision making. Five patients evolved with normal development and one with mild delay. Only one patient required shunt. Hydrocephalus was solved after endovascular treatment in the rest of the patients. Regarding the five AVMs, four were treated with microsurgical approach achieving total resection of the lesion and normal developmental milestones except for one patient with brainstem AVM that was admitted with quadriparesis and coma. In the patient with basal ganglia AVM, the lesion spontaneously disappeared. From the two pial AVFs, the frontal one was microsurgically treated and the spinal one received endovascular session achieving 50% of lesion occlusion for which further treatment is needed. The two cavernous malformations were operated achieving total resection with normal development. The two children with DSM received surgical resection without complications and normal development. The rare case of sacular aneurysm at this age was occluded at the time of diagnostic procedure due to the bad clinical condition of the patient and the hematoma was removed immediately in the operating room. The only case of DAVF died of respiratory intercurrence after three sessions of endovascular treatment. CONCLUSIONS In this neonatal age group (first year of life), we can find the whole range of neurosurgical vascular pathology: VGAM, AVM, cavernous malformation, DSM, pial AVF, DAVF, and sacular aneurysm. VGAM is the most frequent vascular malformation during the first year of age. The early treatment of vascular malformations prevents its adverse effects on a developing brain. A multidisciplinary team composed by endovascular and surgical specialists is necessary to discuss and treat each case.
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22
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Purdy IB, Halnon N, Singh N, Milisavljevic V. Vein of Galen arteriovenous malformation with PAPVR and use of serial B-type natriuretic peptide levels in the management: a case report and review of the literature. CASES JOURNAL 2010; 3:43. [PMID: 20205818 PMCID: PMC2824638 DOI: 10.1186/1757-1626-3-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 02/02/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Arteriovenous malformation of the vein of Galen with partial anomalous pulmonary venous return can lead to a critically challenging condition associated with a high morbidity and mortality. CASE REPORT We report a case of a full term infant born with a vein of Gallen arteriovenous malformation complicated by partial anomalous pulmonary venous return and congestive heart failure where B-type natriuretic peptide was used as a vital tool in clinical assessment and treatment management. CONCLUSIONS Rapid diagnosis and treatment in infants with complex conditions such as this are imperative to expedite appropriate treatments, preventing long term negative outcome.
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Affiliation(s)
- Isabell B Purdy
- Department of Pediatrics, Division of Neonatology & Developmental Biology, David Geffen School of Medicine at University of California at Los Angeles, 10833 Le Conte Avenue, Room B2-375 MDCC, Los Angeles, CA 90095, USA.
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Abstract
A vein of Galen malformation is a rare intracranial vascular lesion affecting the pediatric population. Its poor prognosis has been significantly improved with the development of endovascular embolization. In this paper the authors review the developmental mechanisms, clinical pathophysiology, and the available data on the management and outcome of the disease.
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Affiliation(s)
- Stanley Hoang
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California, USA
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25
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Komiyama M, Honnda Y, Matsusaka Y, Morikawa T, Kitano S, Sakamoto H. Cerebral diagnostic and therapeutic angiography for neonatal arteriovenous fistulas. Interv Neuroradiol 2008; 10 Suppl 1:39-42. [PMID: 20587270 DOI: 10.1177/15910199040100s104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2004] [Accepted: 01/20/2004] [Indexed: 11/17/2022] Open
Abstract
SUMMARY Cerebral diagnostic and therapeutic angiography for neonatal arteriovenous fistulas is reported. Three neonatal boys with vein of Galen aneurysmal malformation (1 patient) and dural arteriovenous fistulas (2 patients) presented severe congestive heart failure soon after birth, and were treated by transarterial and/or transvenous embolization using various access routes. In the neonatal period, umbilical approach and direct cervical approach provide unique access routes in addition to the usual transfemoral route. Characteristics of neonatal angiography are discussed.
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Affiliation(s)
- M Komiyama
- Department of Neurosurgery, Osaka City General Hospital; Osaka -
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Karam O, da Cruz E, Rimensberger PC. VGAM induced high-flow congestive heart failure responsive to PGE1 infusion. Int J Cardiol 2007; 132:e60-2. [PMID: 18022260 DOI: 10.1016/j.ijcard.2007.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 08/18/2007] [Indexed: 11/27/2022]
Abstract
Vein of Galen Aneurismal Malformation (VGAM), a rare congenital anomaly, can lead to congestive heart failure (CHF) and persistent pulmonary hypertension (PHT). Inotropic drugs, diuretics, mechanical ventilation or inhaled nitric oxide (iNO) are the main therapeutic strategies but often do not suffice to control the severe diastolic overload, thus other strategies must be sought. A term male infant was admitted on the second day of life with CHF. Echocardiography revealed normal cardiac anatomy but severe suprasystemic PHT and global volume overload. This led to the diagnosis of VGAM. CHF progressed rapidly to intractable cardiac failure refractory to diuretics, inotropics, oxygen supplementation and iNO. Prostaglandin E1 (PGE1) infusion was therefore started on the third day of life, while awaiting percutaneous occlusion of the fistula. With this treatment, cardiogenic shock could be reversed with rapid improvement of the existing lactic acidosis (lactate levels decreased from 17 to 4.5 mmol/L; base excess from -11.9 to -1.1). Unfortunately, during percutaneous embolisation sudden massive intracerebral hemorrhage occurred leading to death. Patients with refractory cardiac failure and suprasystemic pulmonary hypertension caused by VGAM might benefit of PGE1 infusion to ensure a decompressive right-to-left ductal shunting and thereby maintain an adequate systemic blood flow while awaiting treatment of the aneurismal arteries.
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Wong FY, Mitchell PJ, Tress BM, Dargaville PA, Loughnan PM. Hemodynamic disturbances associated with endovascular embolization in newborn infants with vein of Galen malformation. J Perinatol 2006; 26:273-8. [PMID: 16554851 DOI: 10.1038/sj.jp.7211479] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine hemodynamic changes following endovascular embolization in newborn infants with vein of Galen malformation and severe cardiac failure in the first week of life. STUDY DESIGN Over a recent 5-year period, nine such infants were identified. In seven of these infants, changes in arterial blood pressure were analyzed in relation to the timing of embolization procedures. RESULTS A significant increase in arterial blood pressure was noted after most embolizations. In two infants, this systemic hypertension was severe and treated using intravenous antihypertensive drugs. Both infants subsequently developed complete infarction of both cerebral hemispheres with sparing of the brainstem and cerebellum. Mortality in the nine infants was 33%, and 83% of the survivors were neurologically normal or near normal at follow-up. CONCLUSION The systemic hypertension observed following endovascular embolizations may provide a protective mechanism to maintain cerebral blood flow after reperfusion injury. Lowering blood pressure in this situation may therefore be detrimental.
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Affiliation(s)
- F Y Wong
- Department of Neonatology, The Royal Children's Hospital, Melbourne, Australia.
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Nakano S, Agid R, Klurfan P, dos Santos Souza MP, Armstrong D, Terbrugge KG. Limitations and technical considerations of endovascular treatment in neonates with high-flow arteriovenous shunts presenting with congestive heart failure: report of two cases. Childs Nerv Syst 2006; 22:13-7. [PMID: 16187145 DOI: 10.1007/s00381-005-1237-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 04/12/2005] [Indexed: 10/25/2022]
Abstract
CASE REPORT We report two neonatal patients with high-flow intracranial or cervical arteriovenous (AV) shunts who presented with congestive heart failure and were successfully managed with endovascular treatment. One with vein of Galen malformation with body weight of only 2.0 kg is, to our knowledge, the smallest neonate successfully treated with endovascular treatment. The other neonate is, to our knowledge, the first vertebro-vertebral fistula patient presenting with heart failure and treated successfully with endovascular treatment. CONCLUSION Even in neonates, endovascular treatment is the procedure of choice for high-flow AV shunts presenting with progressive congestive heart failure resistant to medical management. We discuss limitations and technical considerations of endovascular treatments in small neonates with high-flow AV shunts and congestive heart failure.
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Affiliation(s)
- Shinichi Nakano
- Division of Neuroradiology, Department of Medical Imaging, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
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Beucher G, Fossey C, Belloy F, Richter B, Herlicoviez M, Dreyfus M. [Antenatal diagnosis and management of vein of Galen aneurysm: review illustrated by a case report]. ACTA ACUST UNITED AC 2005; 34:613-9. [PMID: 16208207 DOI: 10.1016/s0368-2315(05)82889-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vein of Galen aneurysm is a rare vascular congenital malformation. We report an antenatal diagnosis with duplex Doppler at 26 weeks gestation. Magnetic resonance imaging was used before and after delivery in order to determine neurological prognosis. The neonatal prognosis is poor if fetal cardiac insufficiency or cerebral lesions are present antenatally. Premature delivery does not improve the neonatal outcome. When the aneurysm is not life threatening, embolization of the malformation is at best delayed five months after birth.
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Affiliation(s)
- G Beucher
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, avenue Clémenceau, 14033 Caen Cedex
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Gailloud P, O'Riordan DP, Burger I, Levrier O, Jallo G, Tamargo RJ, Murphy KJ, Lehmann CU. Diagnosis and management of vein of galen aneurysmal malformations. J Perinatol 2005; 25:542-51. [PMID: 16015373 DOI: 10.1038/sj.jp.7211349] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vein of Galen aneurysmal malformations (VGAM) are rare intracranial vascular anomalies typically found in children. The anatomic landmark of a VGAM is the presence of multiple arteriovenous shunts draining into a dilated median prosencephalic vein, an embryonic vessel normally absent at the adult stage. This article reviews the developmental anatomy, the clinical presentation, and the current management of VGAM.
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Affiliation(s)
- Philippe Gailloud
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Ashida Y, Miyahara H, Sawada H, Mitani Y, Maruyama K. Anesthetic management of a neonate with vein of Galen aneurysmal malformations and severe pulmonary hypertension. Paediatr Anaesth 2005; 15:525-8. [PMID: 15910357 DOI: 10.1111/j.1460-9592.2005.01471.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vein of Galen aneurysmal malformations (VGAMs) are rare congenital vascular malformations and excessive arteriovenous shunt causes intractable congestive high-output heart failure in the neonate. We report a case of successful staged transcatheter embolizations for a neonate with congestive heart failure and pulmonary hypertension (PH). Heart failure was dramatically relieved as the staged procedure progressed. Although transcatheter embolizations is essential for the treatment, inhaled nitric oxide (iNO) was helpful as a bridge treatment to reduce right-to-left shunt before the initial emergency embolization. Endovascular embolization is a less invasive therapy than open cranial surgery and allows hemodynamic stability. Perioperative iNO can be used to manage PH in VGAMs.
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Affiliation(s)
- Yuki Ashida
- Department of Anesthesiology, Mie University School of Medicine, Mie, Japan
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Abstract
Childhood cerebrovascular disease is characterised by a wide range of relatively rare conditions. The management of a selection of some of the more frequently encountered, complex conditions is reviewed. The key to achieving the optimal therapeutic strategy for the individual child is multidisciplinary team management within a specialist neurovascular team. Access to rehabilitation is crucial.
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Komiyama M, Nakajima H, Nishikawa M, Yamanaka K, Iwai Y, Yasui T, Morikawa T, Kitano S, Sakamoto H, Nishio A. Vein of galen aneurysms. Experience with eleven cases. Interv Neuroradiol 2002; 7:99-103. [PMID: 20663385 DOI: 10.1177/15910199010070s114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2001] [Accepted: 09/15/2001] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Eleven patients with so-called "vein of Galen aneurysms" are reported, six of whom presented with vein of Galen aneurysmal malformations (four with choroidal type and two with mural type malformations). The remaining five patients presented with vein of Galen aneurysmal dilatations secondarily due to an arteriovenous malformation in one patient, an arteriovenous fistula in another, dural arteriovenous fistulas in two patients, and a varix in another. Treatments for these patients were individualised with consideration given to the clinical manifestations and the angioarchitecture of their lesions. Endovascular intervention played a critical role in the treatment of these vein of Galen aneurysms.
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Affiliation(s)
- M Komiyama
- Department of Neurosurgery, Osaka City General Hospital; Osaka, Japan -
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Berge J, Maugey B, Charles D, Jimenez M, Mangione R. Correlation of prenatal MRI and autopsy findings in the diagnosis of vein of galen arteriovenous malformation. Interv Neuroradiol 2001; 7:135-40. [PMID: 20663340 DOI: 10.1177/159101990100700208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2001] [Accepted: 03/25/2001] [Indexed: 11/15/2022] Open
Abstract
SUMMARY We report the case of an arteriovenous malformation (AVM) of the vein of Galen diagnosed in utero at the 34th week of gestation by ultrasound and MRI. Following interdisciplinary advice, the family decided to terminate the pregnancy. This was carried out in the 36th week of gestation. Mascroscopic study of the fetus confirmed the in utero diagnosis: considerable dilatation of the cerebral arteries, the Galen vein and the anteroinferior sinuses. Based on the correlation of pre and post natal examinations, this study highlights the accuracy of in utero MRI, coupled with ultrasound scanning in the diagnosis of an AVM of the Galen vein. It provides specific information on the degree of cerebral impairment. MRI in utero helps in decision-making for pregnancy termination.
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Affiliation(s)
- J Berge
- Neuroradiology Department, Hôpital Pellegrin; Bordeaux, France
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35
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Komiyama M, Nishikawa M, Kitano S, Sakamoto H, Miyagi N, Kusuda S, Sugimoto H. Transumbilical embolization of a congenital dural arteriovenous fistula at the torcular herophili in a neonate. Case report. J Neurosurg 1999; 90:964-9. [PMID: 10223467 DOI: 10.3171/jns.1999.90.5.0964] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A neonate, in whom a congenital cerebral vascular anomaly had been diagnosed prenatally, exhibited progressive high-output congestive heart failure soon after birth. Cerebral angiography revealed a congenital dural arteriovenous fistula (AVF) with a huge dural lake located at the torcular herophili. In addition to the meningeal blood supply, an unusual pial blood supply from all cerebellar arteries was observed to feed the fistula. The patient was treated by repeated transarterial and transvenous embolization through the umbilical venous route. To the authors' knowledge, neither the existence of a congenital dural AVF at the torcular herophili presenting with an enormous pial blood supply or the technique of trans-umbilical venous intervention has been reported in the literature.
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Affiliation(s)
- M Komiyama
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Miyakojima, Japan.
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Affiliation(s)
- P L Mendoza
- Department of Pediatrics, Beth Israel Medical Center/North Division, New York, New York, USA
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