Introduction Neonates with Vein of Galen malformations (VOGM) require early assessment to determine the need for endovascular embolization. The Bicêtre Neonatal Evaluation Score, a 21-point risk stratification score published in 2006, was historically used to inform management: under 8 points suggested withdrawing treatment, 8 to 12 points suggested neonatal intervention, and over 12 points suggested delaying to the infantile period. However, the score is no longer strictly employed and may bias outcomes. As endovascular techniques and technology have improved over time, a new decision-making paradigm may more accurately reflect modern treatment outcomes.

Methods A single-center retrospective review identified all VOGM patients presenting in the neonatal period from January 2012 to May 2023. Patients were included if they had fetal or neonatal imaging within the first ten days of life and if they had not previously received intervention. Intervention at our center was offered based on the neonate’s cardiopulmonary status, neurologic status, and responsiveness to medical management. Bicêtre scores were retrospectively calculated from available data at the time of the decision to offer neonatal or infantile intervention.

Results Forty-four patients with VOGM were identified. Twenty-six patients received neonatal intervention, with Bicêtre scores ranging from 6 to 17, and 18 patients were delayed for infantile intervention with Bicêtre scores ranging from 17 to 21. The median Bicêtre score of the neonatal treatment group was 14.5 with interquartile range of 12.75–15.25. The median Bicêtre score of the infantile treatment group was 21 with interquartile range of 19.5–21. No infants (0%) and three neonates (11.5%) with scores 9, 12, and 16 expired despite neonatal embolization, compared to 7.2% of infants and 52% of neonates in the Bicêtre series. One neonate (2.3%) experienced massive postprocedural hemorrhage with subsequent mortality, compared to 5.6% of patients in the Bicêtre series.

Conclusions Our window of acceptable Bicêtre scores for neonatal embolization has increased in range and trended toward higher scores with improved mortality compared to the original case series. An updated risk stratification algorithm is necessary to ensure that intervention is not inappropriately delayed or withheld entirely in patients who may benefit from early embolization.

Disclosures A. Devarajan: None. T. Shigematsu: None. J. Bonet: None. D. Goldman: None. B. Philbrick: None. P. Morgenstern: None. M. Sorscher: None. W. Molofsky: None. S. Ghatan: None. A. Berenstein: None. J. Fifi: None.