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Case series
Evolution of transvenous embolization in vein of Galen malformation: case series and review of the literature
  1. Johanna T Fifi1,2,
  2. Maximilian Jeremy Bazil1,
  3. Stavros Matsoukas1,
  4. Tomoyoshi Shigematsu1,
  5. Michelle Sorscher1,
  6. Alejandro Berenstein1
  1. 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Johanna T Fifi, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Johanna.Fifi{at}mountsinai.org

Abstract

Background Treatment of vein of Galen malformations (VOGMs) has improved greatly since the inception of endovascular treatment. Transvenous embolization (TVE) is an attractive option to achieve complete obliteration.

Objective To review the literature on TVE of VOGM and then analyze our practice’s unique experience and evolving treatment strategies over 30 years.

Methods A retrospective review of our clinical database for patients with the diagnosis of VOGM treated between January 2004 and August 2021 was performed. A literature review of 49 relevant articles was also carried out.

Results TVE in VOGM has evolved with initial introduction as a transtorcular (TT) approach, which then lost favor to transarterial embolization (TAE). TAE has been considered the more favorable approach in most high-volume centers. In more recent times, the transvenous embolization (TVE) approach has been revisited as a last treatment to achieve a cure after a series of TAE treatments. We presently favor beginning treatment with staged TAE to reduce flow to the lesion and, importantly, shrink the draining vein. This then allows for the performance of TVE with the Chapot pressure cooker technique (CPCT) with coils and liquid embolic embolization.

Conclusions TT TVE itself carries a high degree of risk and is most highly associated with long-term morbidities and mortality. Traditional transfemoral/transjugular TVE approaches are safe and effective in simple fistulas with a small venous pouch; however, we believe that the CPCT is the safest technique as a last-stage treatment for its security in avoiding reflux and obtaining occlusion of the small perforators.

  • Vascular Malformation
  • Technique
  • Pediatrics
  • Malformation
  • Arteriovenous Malformation

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Footnotes

  • Twitter @StavrosMatsouk

  • Contributors MJB wrote the manuscript, performed statistical analysis, performed the literature review, and completed edits. SM provided important feedback and editing for the manuscript. JTF, TS, MS, and AB treated all patients in this series, reviewed the manuscript, provided the necessary guidance and information to complete the manuscript, translated the Chapot pressure cooker technique from arteriovenous malformation to vein of Galen malformation, and provided feedback for reviewer comments.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JTF is a member of the SNIS Board of Directors. JTF is a consultant for Stryker, Cerenovus, Penumbra, and Microvention.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.