Abstract 1122‐000110: Transvenous Embolization in Vein of Galen Malformations as the Last Procedure
Introduction : Vein of Galen Malformations (VOGM) are a rare, congenital, vascular malformation representing <1% of all arteriovenous malformations. Treatment is typically performed in infancy and transarterial embolization (TAE) is the most common treatment method. While conventional methods allow for a total or near‐total obliteration in 80% of cases, there is a subset of patients for whom TAE is ineffective (E.g. the residual arterial supply is through small feeders non‐amenable to TAE). In these cases, transvenous embolization or coiling (TVE) is the technically simplest approach. We assessed the immediate angiographic and clinical outcomes of our VOGM cases treated with TVE. All relative technical details are reported. Immediate angiographic outcomes and clinical outcomes are reported. Methods : A retrospective review of our institutional database was performed to identify all VOGM patients who underwent TVE as the final‐stage procedure between January 2004 and December 2020. Results : We describe a cohort of 13 patients, one of whom underwent partial TVE for palliative measures and was excluded. All of the 12 patients that met our eligibility criteria had undergone more than 3 transarterial embolizations with nBCA. The mean age of our cohort was 8.2 (SD: 6.3) years. Ten patients were treated with coils and two with the Chapot “Pressure cooker” (ChPC) Technique. In these two cases, predicting hemorrhage post‐procedurally proved difficult; as a result, we attempted to occlude the remaining arterial supply using transvenous ChPC. Complete immediate angiographic obliteration was achieved in nine patients. Stereotactic radiosurgery was performed in 2 of the remaining patients and full obliteration was achieved. Immediate post‐procedural (within 48 hours) hemorrhagic complications were noted in two patients treated with coils: one of these ended in mortality and the second suffered from significant neurological impairment. In total, eight patients had normal development, three had a moderate delay with hemiparesis and one patient died. Conclusions : To the best of our knowledge, this is the first report of TVE being used as a final‐stage cure attempt for VOGMs after multiple TAE sessions. We advocate that TVE for the treatment of VOGMs is a feasible option as a final‐stage attempt for cure. It is particularly effective if the dilated VOG becomes small enough. To prevent incomplete occlusion and reduce the risk of post‐procedural hemorrhagic complications, the ChPC technique using liquid embolic material should be considered.