Objective Vein of Galen aneurysmal malformation is a rare congenital cerebrovascular disorder whose natural course has almost no favorable outcomes (<1%). Our objective was to analyze the outcomes of endovascular treatment of patients with vein of Galen aneurysmal malformation (VGM) during the first days of their life.
Materials and Methods During the period between January 2013 and February 2020, 52 patients with vein of Galen malformations were operated on at the National Medical Research Center named after Academician E.A. Meshalkin. Eleven of these patients were younger than 10 days when surgery was performed. Twelve endovascular embolization sessions were conducted via a transarterial approach. Cyanacrylate glue was used in 10 cases (mural VGMs); in one case, Phil 25 non-adhesive liquid embolic system was used and two embolization stages were performed (choroidal VGM). All patients were hospitalized in an intensive care unit having the Bicêtre score of 10–12. Prior to surgery, all patients underwent cardiac ultrasonography (that involved measuring pulmonary artery pressure) and neurosonography that involved measuring the linear blood flow velocity (LBFV) in the vein of Galen and afferent vessels. All patients had pronounced pulmonary hypertension; LBFV in the vein of Galen was ≥ 0.6 m/s.
Results Linear blood flow velocity (LBFV) in the vein of Galen was assessed intraoperatively in all patients. The operative treatment stage was completed when the LBFV in the vein of Galen decreased to 25–50% of the initial value. Echo imaging showed that pulmonary hypertension was significantly reduced in 10 patients during the postoperative period, except in a patient with a choroidal subtype of vein of Galen malformation. Favorable outcomes were observed for eight (72.7%) patients. Two (18.8%) patients developed complications, both being caused by intracranial hemorrhage. Two patients who had been operated on died (16.6%).
Conclusions Endovascular treatment of vein of Galen aneurysmal malformations in neonates with severe pulmonary hypertension is feasible. This technique reduces the severity of pulmonary hypertension, thus lowering the risk for developing critical heart failure or multiple organ failure, and allows patients to cross the critical line on their way to survival. To be treated using endovascular surgery, patients need to undergo meticulous selection, and surgical treatment should be used only if they have the mural subtype of vein of Galen malformations. The initially poor patient‘s condition (the Bicêtre score <8), the choroidal subtype of malformation, and concurrent cardiac malformations are the factors preventing the favorable outcome of endovascular treatment of vein of Galen malformations in neonates.
Disclosures P. Seleznev: None. K. Orlov: None. V. Berestov: None. A. Gorbatykh: None. D. Kislitsyn: None. T. Shayakhmetov: None. N. Strelnikov: None.
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