Introduction Vein of Galen Malformations (VOGM) are congenital arteriovenous malformations (AVM) which are primarily treated by endovascular embolization. Current treatment involves staged transarterial embolization (TAE) for progressive obliteration of the fistula. However, TAE alone does not always completely close the malformation. To close the malformation and achieve angiographic cure, these staged TAEs can be followed by a final curative transvenous embolization (TVE). The pressure cooker technique (PCT) has gained popularity as a novel and effective TVE technique for the curative embolization of high-flow AVMs. Here, we aim to characterize the angiographic and clinical outcomes of a large cohort of patients who were cured of VOGM with a final curative embolization by PCT.

Methods A retrospective chart review at two high-volume endovascular centers identified all patients with VOGM who were cured by TVE using the pressure cooker technique. Initial clinical presentation, presentation at TVE, clinical and angiographic outcomes, and technical parameters were reviewed.

Results 15 patients were treated for their VOGM with a final curative TVE by PCT. All patients had a choroidal VOGM (15/15, 100%) which had been previously embolized by staged TAE. Patients initially presented at a median age of 8 months with hydrocephalus, congestive heart failure, and developmental delay. The median age at TVE was 3.614 years and patients presented with hemiplegia, seizures, developmental delay, and persistent hydrocephalus. Technical success was achieved in 100% of PCTs (15/15). Postoperatively, two patients experienced small intraventricular hemorrhage requiring subsequent EVD placement, but recovered without permanent neurologic deficit. All 11 patients who have received follow-up angiograms continue to demonstrate complete obliteration of the malformation. On clinical follow-up, all patients (15/15, 100%) were either asymptomatic or demonstrated notable progression in milestones.

Conclusion The pressure cooker technique offers an attractive option to achieve curative embolization of VOGM by TVE. Patients who received curative embolization using PCT demonstrated persistent angiographic cure and excellent clinical outcomes even at long-term clinical follow-up.

Disclosures A. Devarajan: None. T. Shigematsu: None. H. Tabani: None. A. Schupper: None. C. Rossitto: None. J. Bonet: None. M. Sorscher: None. P. Morgenstern: None. S. Ghatan: None. A. Berenstein: None. R. Chapot: None. J. Fifi: None.