Scepter mini assisted angiographic cure of a Vein of Galen Malformation with n-butyl cyanoacrylate

2021 ◽  
pp. 159101992199336
Author(s):  
Timothy G White ◽  
Amir R Dehdashti ◽  
Henry H Woo
Keyword(s):  
Clinical Presentation ◽  
Balloon Catheter ◽  
Standard Of Care ◽  
Endovascular Embolization ◽  
Easy Access ◽  
The Novel ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Multiple Treatment ◽  
Staged Approach

Background Even in the modern endovascular era, the treatment of Vein of Galen Malformations (VOGM) is extremely challenging. While their natural history is very poor, endovascular embolization has emerged as the standard of care. These lesions often require multiple treatment sessions to decrease shunting, with each treatment including multiple pedicles. Here we present the first reported use of the Scepter Mini (Microvention, Aliso Viejo, CA) in the treatment of vein of Galen malformations. Clinical presentation A 7 month old female presented with an enlarging VOGM that was initially identified on prenatal ultrasound. Given the enlarging size of the lesion and failure to meet developmental milestones, the patient underwent planned endovascular embolization of the VOGM. The novel Scepter Mini balloon catheter was used for treatment of this lesion affording easy access to the target pedicle and immediate flow arrest which allowed for immediate cure of the lesion. Conclusion The novel Scepter Mini Balloon (Microvention, Aliso Viejo, CA) afforded excellent distal access with subsequent immediate flow arrest therefore facilitating endovascular cure. Initially, a staged approach was favored for the treatment of the lesion, but the flow arrest achieved by the Scepter mini facilitated immediate occlusion from a single pedicle.

Fistulous-type vein of Galen malformation phantom model for endovascular training and research

2016 ◽  
Vol 9 (9) ◽  
pp. 880-886
Author(s):  
Dan Meila ◽  
Katharina Melber ◽  
Dominik Grieb ◽  
Collin Jacobs ◽  
Heinrich Lanfermann ◽  
...  
Keyword(s):  
Treatment Options ◽  
Endovascular Embolization ◽  
High Flow ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Phantom Model ◽  
Before And After ◽  
And Training

IntroductionVein of Galen malformation (VGM), a high-flow intracranial arteriovenous shunt, is among the most severe neurovascular diseases in childhood. In many cases untreated children die or survive only severely disabled. Endovascular embolization is the preferred treatment.ObjectiveTo develop a simple fistulous-type VGM phantom model for teaching and training of different endovascular treatment methods and to investigate new treatment options and devices.MethodsAn experimental in vitro pulsatile phantom model was developed imitating a high-flow fistulous-type VGM, which is typical, especially in the neonatal phase. Pressure measurements at different arterial sites were performed before and after closure of the VGM. Closure of the VGM was achieved by coiling using a combined microcatheter-based transvenous and transarterial approach called ‘kissing microcatheter technique’.ResultsThe behaviour of the phantom model in vitro under fluoroscopy and under angiographic runs was extremely similar to that in in vivo conditions in children. The results showed that intra-arterial pressures changed and increased statistically significantly at all measurement sites after embolization, as in human arteriovenous malformation. We also demonstrated different and complementary visualizations of hemodynamics and angioarchitecture by antegrade and retrograde microcatheter injections.ConclusionsOur phantom model behaves like a typical fistulous-type VGM and can be used in vitro for teaching and training and for further research. It offers a new and better understanding of hemodynamics and angioarchitecture in the endovascular management of VGM.

scholarly journals Vein of Galen malformation

2009 ◽  
Vol 27 (5) ◽  
pp. E8 ◽  
Author(s):  
Stanley Hoang ◽  
Omar Choudhri ◽  
Michael Edwards ◽  
Raphael Guzman
Keyword(s):  
Poor Prognosis ◽  
Pediatric Population ◽  
Vascular Lesion ◽  
Endovascular Embolization ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Developmental Mechanisms

A vein of Galen malformation is a rare intracranial vascular lesion affecting the pediatric population. Its poor prognosis has been significantly improved with the development of endovascular embolization. In this paper the authors review the developmental mechanisms, clinical pathophysiology, and the available data on the management and outcome of the disease.

scholarly journals Targeted Neonatal Echocardiography-Guided Therapy in Vein of Galen Aneurysmal Malformation: A Report of Two Cases with a Review of Physiology and Approach to Management

2019 ◽  
Vol 09 (02) ◽  
pp. e172-e176 ◽  
Author(s):  
R. E. Giesinger ◽  
Y. N. Elsayed ◽  
M. P. Castaldo ◽  
P. J. McNamara
Keyword(s):  
Ductus Arteriosus ◽  
Endovascular Embolization ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Systemic Blood ◽  
Systemic Blood Flow ◽  
Ventricular Performance ◽  
Right Ventricular Performance ◽  
Neonatal Echocardiography ◽  
Guided Therapy

AbstractVein of Galen malformation results in predictable changes in physiology which exist on a continuum. Severe pulmonary hypertension may present as hypoxemia; however, excessive reduction in pulmonary vascular resistance may precipitate progressive pulmonary overcirculation and impaired systemic blood flow. Right ventricular performance and the patency and direction of the ductus arteriosus may play a crucial role in postductal organ perfusion. Physiological stabilization may be complex and variable over time. The utilization of targeted neonatal echocardiography to guide treatment decisions may improve the ability to provide therapy tailored to the specific disease pathophysiology and monitor serially as conditions change. An enhanced approach to physiological stabilization may reduce the risk of unexpected decompensation and allow for thoughtful, controlled endovascular embolization in appropriate candidates.

scholarly journals Neurocognitive improvements following endovascular repair of vein of Galen malformation in a child

2015 ◽  
Vol 15 (2) ◽  
pp. 197-202 ◽  
Author(s):  
Robyn A. Howarth ◽  
Andrew Reisner ◽  
Joshua J. Chern ◽  
Laura L. Hayes ◽  
Thomas G. Burns ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Endovascular Repair ◽  
Endovascular Embolization ◽  
Initial Presentation ◽  
Cognitive Deterioration ◽  
Vein Of Galen ◽  
Neurocognitive Deficits ◽  
Vein Of Galen Malformation ◽  
Neurocognitive Profile

Cognitive regression is a well-described presentation of vein of Galen aneurysmal malformations (VGAMs) in childhood. However, it remains unclear whether successful treatment of the malformation can reverse cognitive regression. Here, the authors present the case of a 5-year-old girl with a VGAM that was treated with staged endovascular embolization procedures. Comprehensive neurocognitive assessments were completed before intervention and approximately 6 years after initial presentation. There were significant age-matched improvements in this child's neurocognitive profile over this period. The authors believe that timely and successful treatment of VGAM in children may not only stabilize the associated cognitive deterioration but, in some cases, may ameliorate these deficits. Details of this case and a discussion of neurocognitive deficits related to VGAM are presented.

Vein of Galen Malformation

2018 ◽  
Author(s):  
Elizabeth C. Eastburn ◽  
Mary Landrigan-Ossar
Keyword(s):  
Vascular Lesion ◽  
Endovascular Embolization ◽  
Neurological Dysfunction ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Initial Symptoms ◽  
History Of ◽  
Flow Through ◽  
Intracranial Vascular Malformation ◽  
Selection Of

Vein of Galen malformation (VGM) is a high-flow intracranial vascular malformation, presenting in utero or after birth with a range of initial symptoms. The natural history of untreated VGM is grave, with progressive permanent neurological dysfunction, developmental delay, seizures, intracranial hemorrhage, and death. Presentation varies with age, with more severe manifestations resulting in earlier presentation and poorer outcome. The mainstay of treatment is medical stabilization followed by endovascular embolization. The goal is to reduce flow through the malformation such that normal development can proceed without neurological deficit. The past 20 years have seen great advances both in the technical treatment of the vascular lesion and in the overall prognosis of patients treated for this condition. Key to a good outcome is appropriate selection of patients and treatment by physicians familiar with this pathophysiology.

scholarly journals Hemodynamic disturbances associated with endovascular embolization in newborn infants with vein of Galen malformation

2006 ◽  
Vol 26 (5) ◽  
pp. 273-278 ◽  
Author(s):  
F Y Wong ◽  
P J Mitchell ◽  
B M Tress ◽  
P A Dargaville ◽  
P M Loughnan
Keyword(s):  
Newborn Infants ◽  
Endovascular Embolization ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation

scholarly journals Vein of Galen Aneurysmal Malformations in Pediatric Patients Submitted to Endovascular Treatment: Report of 3 Cases

2021 ◽  
Author(s):  
Amanda Cristina Zimmermann ◽  
Bernardo Przysiezny ◽  
Evelyn Della Giustina ◽  
Guilherme Voltolini Staedele ◽  
Leandro José Haas ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Endovascular Embolization ◽  
High Morbidity ◽  
Vein Of Galen ◽  
Neurological Damage ◽  
Vascular Abnormalities ◽  
Neonatal Stage

Abstract Objective To report three cases of vein of Galen aneurysmal malformation (VGAM) in pediatric patients treated at the hemodynamics lab of Hospital Santa Isabel (HSI) in Blumenau, state of Santa Catarina, Brazil, from 2006 to 2020. Clinical presentation, endovascular treatment, and postprocedure evolution to date are included. Case description Three children aged 5 to 12 months with cardiac, respiratory, or neurological damage in the neonatal stage, were referred to the neurosurgery service and diagnosed with VGAM. The three patients underwent endovascular embolization of the malformation, with different clinical evolution throughout outpatient follow-up. Conclusion Vein of Galen aneurysmal malformations are uncommon vascular abnormalities that, until the advent of endovascular embolization, were associated with high morbidity and mortality rates. Its prognosis is linked with initial clinic, early diagnosis, and timely surgical correction.

Vein of Galen Malformations: The Texas Children's Hospital Experience in the Modern Endovascular Era

2019 ◽  
Vol 17 (3) ◽  
pp. 286-292 ◽  
Author(s):  
Kathryn M Wagner ◽  
Michael G Z Ghali ◽  
Visish M Srinivasan ◽  
Sandi Lam ◽  
Jeremiah Johnson ◽  
...  
Keyword(s):  
Balloon Catheter ◽  
Lessons Learned ◽  
Vein Of Galen ◽  
Vessel Occlusion ◽  
Systemic Complications ◽  
Children's Hospital ◽  
Multiple Treatment ◽  
Children’S Hospital ◽  
Systemic Symptoms ◽  
Surgical Treatments

Abstract BACKGROUND Vein of Galen malformations (VOGM) comprise nearly a third of pediatric cerebrovascular anomalies, with potentially devastating neurological and systemic complications. Advances in endovascular therapies have dramatically improved outcomes compared to historical surgical treatments, and neurosurgeons are an essential component of the multidisciplinary critical care team. OBJECTIVE To retrospectively review pediatric patients with VOGM treated at Texas Children's Hospital (TCH), a quaternary referral center, over 15 yr, and present lessons learned in treating children with modern endovascular techniques. METHODS Charts from TCH were retrospectively reviewed for the past 15 yr. Patients with diagnosis including “Vein of Galen,” “Vein of Galen malformation,” “Vein of Galen aneurysmal malformation,” or any abbreviations (ie, VOG, VOGM, VOGAM) were reviewed. Presentation, imaging, treatment specifics, and clinical outcomes were reported. RESULTS There were 18 patients with VOGM managed at TCH from 2002 to 2018 with a total of 29 embolizations. Seventeen were performed with a single embolisate (NBCA or Onyx), and 12 with a combination. A dual lumen balloon catheter was used as an adjunct in 3 embolizations. Complications occurred in 5 embolizations (24%), including hemorrhage, embolisate migration, and femoral vessel occlusion. Surviving patients were followed for a mean of 38 mo, with 12 having normal or near-normal neurological development. CONCLUSION VOGM can present with a myriad of neurological and systemic symptoms, potentially in extremis. Neurosurgical involvement in these cases is critical, as urgent treatment can be lifesaving. Patients may require multiple treatment sessions using a variety of endovascular tools and techniques.

EFFICACY OF A NOVEL DEVICE TO DETECT, ALERT AND RESOLVE NEONATAL APNEA - PILOT STUDY

2019 ◽  
Vol 9 (9) ◽  
pp. 608-613
Author(s):  
Dr. Swapna Lingaldinna,Dr. Himabindu Singh,Mona Sharma*
Keyword(s):  
Newborn Care ◽  
Standard Of Care ◽  
The Novel ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Care Community ◽  
Novel Device ◽  
Sick Newborn ◽  
Central Apneas ◽  
Neonatal Apnea

Objective: To measure the accuracy of a novel device in detecting Bradycardia andDesaturation (B&D) events and to determine its efficacy in resolving apneas innewborns with comparison to standard monitor (which only detects B&D eventsand alerts).Design: This was a prospective observational study.Setting: Sick Newborn Care Unit of a large tertiary referral hospital in Hyderabad,India.Methods: 31 newborns were provided with a novel device, which monitored oxygensaturation and pulse rate and alarmed when values dropped below a set thresholdwhich is referred as an event, henceforth. The novel device also provided footstimulation in response to above-mentioned events. When the monitor alarmed, anurse attended to the baby to confirm whether the baby was breathing and whetherthe event had been resolved by the device. If the event had not resolved, appropriateaction as per the standard-of-care was performed.Results: The novel device “ApneBootTM” positively detected B&D events 94.03% oftimes as compared to the standard reference monitor. 56 of 67 observed B&D eventswere visually confirmed to be apneas, indicating that 83.6% of B&D eventscoincided with apneas. Of the 56 apneic events, 50 were central apneas, of which 35were resolved by the novel device, making the device’s efficacy of apnea resolution70%.Conclusion: The results of the study indicate that this novel device “ApneBootTM”is very effective in detecting and alarming B&D events, which coincides with theapnea, and resolving it by providing foot stimulation.Keywords: Novel Device, Neonatal Apnea, Low Birth Weight, Body Temperature,Kangaroo Mother Care, Community Health,

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