Therapeutic alternatives for vein of Galen vascular malformations

1993 ◽  
Vol 78 (3) ◽  
pp. 438-445 ◽  
Author(s):  
Pedro Lylyk ◽  
Fernando Viñuela ◽  
Jacques E. Dion ◽  
Gary Duckwiler ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Vascular Malformations ◽  
Clinical Status ◽  
Severe Congestive Heart Failure ◽  
Type I ◽  
Vein Of Galen ◽  
Content Type ◽  
Type Iv ◽  
Fine Print

✓ From September, 1986, to March, 1990, the authors treated 28 children harboring a vein of Galen vascular malformation. Eleven (39.3%) of the patients were neonates, 13 (46.4%) were 1 to 2 years old, and four (14.3%) were more than 2 years old. Fifteen patients (53.6%) presented with severe congestive heart failure, six (21.4%) had seizures, four (14.3%) had hydrocephalus, and three (10.7%) presented with intraventricular hemorrhage. Based on the Yaşargil classification of malformations, 10 lesions (35.7%) were Type I, seven (25%) were Type II, eight (28.6%) were Type III, and three (10.7%) were Type IV. In 11 patients (39.3%), a combined transfemoral, transarterial, and transvenous embolization of the vein of Galen malformation was performed. A pure transtorcular approach was utilized in eight patients (28.6%), and postembolization surgical clipping of arterial feeders was performed in two cases with intractable congestive heart failure. Complete anatomical occlusion of the galenic malformation was achieved in 13 patients (46.4%). An immediate postembolization improvement in the patient's clinical status was obtained in 23 (82.1%) of 28 patients and a good long-term clinical outcome was seen in 17 patients (60.7%). Five deaths (17.9%) occurred in this series of 28 patients; three (10.7%) were related to a transtorcular embolization and two (7.1%) to the unchanged natural history of the disease.

Gamma surgery for vein of Galen malformations

2000 ◽  
Vol 93 (2) ◽  
pp. 229-236 ◽  
Author(s):  
Bryan Rankin Payne ◽  
Dheerendra Prasad ◽  
Melita Steiner ◽  
Hernan Bunge ◽  
Ladislau Steiner
Keyword(s):  
Additional Patient ◽  
Consecutive Series ◽  
Type I ◽  
Vein Of Galen ◽  
Content Type ◽  
Type Iii ◽  
Type Iv ◽  
Flow Through ◽  
Fine Print

Object. The goal of this study was to evaluate the results of gamma surgery in nine patients treated for vein of Galen malformations (VGMs).Methods. A consecutive series of nine VGMs in eight children aged 4 to 14 years and in one adult were treated with gamma surgery. Six of the patients were male, including the adult, and three were female. Among these patients there were three Yaşargil Type I, one Type II, two Type III, and three Type IV malformations. Previous embolization had failed in four cases. Three VGMs were treated with gamma surgery twice. An additional patient with a Type III VGM underwent stereotactic angiography in preparation for gamma surgery but was judged to be suitable for direct embolization.Follow-up angiograms were obtained in eight of the VGMs treated. Four no longer filled; one has probably been obliterated, but this cannot be confirmed because the patient refused to undergo final angiography; one patient has residual fistulas not included in the initial treatment field, which were retreated recently; and two other patients have marked reduction of flow through their VGMs.Conclusions. Gamma surgery is a viable option in the treatment of VGMs in clinically stable patients. Combined endovascular therapy and gamma surgery is of benefit in complex malformations.

Giant arteriovenous fistula of the vein of Galen in early infancy treated successfully with surgery

1980 ◽  
Vol 53 (5) ◽  
pp. 703-706 ◽  
Author(s):  
Jose Andres Alvarez-Garijo ◽  
Manuel Vila Mengual ◽  
Dario Taboada Gomila ◽  
Adela Alonso Martin
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Vein Of Galen ◽  
Cerebral Damage ◽  
Left Hemiparesis ◽  
Content Type ◽  
Feeding Vessels ◽  
Unusual Lesion ◽  
Persistent Hydrocephalus ◽  
Fine Print

✓ A giant arteriovenous fistula in a newborn infant was treated by surgical occlusion of the feeding vessels at 20 days of life. Congestive heart failure responded favorably to operative treatment. Because of persistent hydrocephalus, a shunt was inserted at 2 months of age. At 9 months of age, the child remained without signs of cardiac failure. Cerebral damage was manifested by a mild left hemiparesis. Successful surgical treatment of this unusual lesion in a neonate is exceptional.

Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae

1994 ◽  
Vol 80 (4) ◽  
pp. 606-616 ◽  
Author(s):  
Sean Mullan
Keyword(s):  
Sinus Thrombosis ◽  
Vascular Malformations ◽  
Venous Malformation ◽  
Venous Pressure ◽  
Venous Occlusion ◽  
Vein Of Galen ◽  
Content Type ◽  
Permanent Cure ◽  
Glue Embolization ◽  
Fine Print

✓ Evidence is presented that dural fistulae are preceded by sinus thrombosis and that their danger lies in arterialized venous pressure within the cranium or the orbit. Arterial side occlusion leads to recurrence, while venous side occlusion leads to permanent cure. Vein of Galen aneurysms embrace some features of cerebral arteriovenous malformations (AVM's), namely a reticulum, and some features of dural fistulae, namely evidence of previous sinus anomaly and direct drainage into a sinus. These aneurysms are also permanently cured by venous side thrombosis, although the dangers inherent in their reticulum demand that this be done in stages or preceded by arterial side embolization. A very limited experience with venous end occlusion of cerebral (and spinal) AVM's suggests that they, too, can be permanently cured by venous side occlusion without excision. Their reticulum demands maximum, multistage, preliminary arterial side embolization together with intraoperative hypotension during the venous occlusion stage in order to minimize intracerebral hemorrhage or swelling. Schematic models of both fistulae and malformations are presented, together with reasons why particulate embolization is safer than glue embolization. The theory is advanced that dural fistulae, vein of Galen aneurysms, and AVM's are venous- rather than arterial-based lesions, which is consistent with the experience that permanent cure has been effected by venous side occlusion without excision in all three anomalies. It is speculated that there may be a developmental link between AVM and the venous malformation, the AVM being essentially a fistulized venous malformation.

scholarly journals Vein of Galen malformation, a rare cause of epilepsy

2016 ◽  
Vol 03 (01) ◽  
pp. 024-025
Author(s):  
Mohammad Sayadnasiri
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Vascular Malformation ◽  
Neonatal Period ◽  
Severe Congestive Heart Failure ◽  
Low Flow ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Venous Structure ◽  
Cerebral Vascular Malformation

AbstractVein of Galen malformation (VOGM) is a rare congenital cerebral vascular malformation characterized by an aneurysmally dilated midline deep venous structure, fed by abnormal arteriovenous communication. Most patients develop severe congestive heart failure at neonatal period that is fatal if left untreated. Rarely, patients with low-flow fistula present with headache, seizure, or focal neurological sign at adulthood. A 28-year-old female with VOGM-related epilepsy was introduced in this brief report.

Hydrocephalus and congestive heart failure caused by intracranial arteriovenous malformations in infants

1972 ◽  
Vol 36 (3) ◽  
pp. 249-254 ◽  
Author(s):  
Sten Cronqvist ◽  
Lars Granholm ◽  
Nils-Rune Lundström
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Operative Treatment ◽  
Arteriovenous Malformations ◽  
Venous Pressure ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Fine Print

✓ Two infants with large intracranial arteriovenous (A–V) malformations associated with hydrocephalus and congestive heart failure responded favorably to operative treatment of the malformation. The fact that the hydrocephalus subsided suggests that raised venous pressure may be important in the production of hydrocephalus.

Cerebrovascular malformation in childhood presenting with cardiomegaly

1971 ◽  
Vol 34 (6) ◽  
pp. 818-822 ◽  
Author(s):  
John R. Taylor ◽  
William E. Bell ◽  
Carl J. Graf
Keyword(s):  
Heart Failure ◽  
Vascular Malformations ◽  
Content Type ◽  
Pathophysiological Mechanisms ◽  
Successful Removal ◽  
Cardiac Status ◽  
Cerebrovascular Malformation ◽  
Careful Assessment ◽  
Fine Print

✓ Cardiomegaly secondary to a cerebrovascular malformation is described in a 4-year-old child, including resolution of the cardiomegaly following successful removal of the malformation. The pathophysiological mechanisms are discussed, as well as the care of such patients during and immediately after surgery. All patients with large vascular malformations should have careful assessment of their cardiac status, and, conversely, the evaluation of patients with unexplained cardiomegaly or heart failure should include a search for vascular malformations.

The syndromes and surgical treatment of aneurysms of the great vein of Galen

1973 ◽  
Vol 39 (1) ◽  
pp. 89-98 ◽  
Author(s):  
A. Loren Amacher ◽  
John Shillito
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Newborn Infants ◽  
Surgical Techniques ◽  
Vein Of Galen ◽  
Content Type ◽  
Point Of Entry ◽  
Feeding Vessels ◽  
Great Vein ◽  
Fine Print

✓ The authors review 37 cases of primary aneurysms of the vein of Galen reported in the literature and present five new ones. The magnitude of the shunt from arterial feeders to the primary aneurysm indicates the age at which the patient's symptoms first appeared as well as the nature and severity of those symptoms. Newborn infants have intractable heart failure, older infants have hydrocephalus, and adolescents have headache and syncope. Four clinical categories, based on the time of onset of symptoms, are described, and the diagnostic studies and surgical techniques discussed. Four-vessel angiography and ligation of the feeding vessels at the point of entry into the vein of Galen are recommended.

The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas

1996 ◽  
Vol 85 (5) ◽  
pp. 830-837 ◽  
Author(s):  
Mark A. Davies ◽  
Karel TerBrugge ◽  
Robert Willinsky ◽  
Terry Coyne ◽  
Jamshid Saleh ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Clinical Presentation ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Type Iii ◽  
Arteriovenous Fistulas ◽  
Type Iv ◽  
Type V ◽  
Fine Print

✓ A number of classification schemes for intracranial dural arteriovenous fistulas (AVFs) have been published that claim to predict which lesions will present in a benign or aggressive fashion based on radiological anatomy. We have tested the validity of two proposed classification schemes for the first time in a large single-institution study. A series of 102 intracranial dural AVFs in 98 patients assessed at a single institution was analyzed. All patients were classified according to two grading scales: the more descriptive schema of Cognard, et al. (Cognard) and that recently proposed by Borden, et al. (Borden). According to the Borden classification, 55 patients were Type I, 18 Type II, and 29 Type III. Using the Cognard classification, 40 patients were Type I, 15 Type IIA, eight Type IIB, 10 Type IIA+B, 13 Type III, 12 Type IV, and four Type V. Intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit was considered an aggressive presenting clinical feature. A total of 16 (16%) of 102 intracranial dural AVFs presented with hemorrhage. Eleven of these hemorrhages (69%) occurred in either anterior cranial fossa or tentorial lesions. When analyzed according to the Borden classification, none (0%) of 55 Type I intracranial dural AVFs, two (11%) of 18 Type II, and 14 (48%) of 29 Type III intracranial dural AVFs presented with hemorrhage (p < 0.0001). After exclusion of visual or cranial nerve deficits that were clearly related to cavernous sinus intracranial dural AVFs, nonhemorrhagic neurological deficits were a feature of presentation in one (2%) of 55 Type I, five (28%) of 18 Type II, and nine (31%) of 29 Type III patients (p < 0.0001). When combined, an aggressive clinical presentation (ICH or nonhemorrhagic neurological deficit) was seen most commonly in intracranial dural AVFs located in the tentorium (11 (79%) of 14) and the anterior cranial fossa (three (75%) of four), but this simply reflected the number of higher grade lesions in these locations. Aggressive clinical presentation strongly correlated with Borden types: one (2%) of 55 Type I, seven (39%) of 18 Type II, and 23 (79%) of 29 Type III patients (p < 0.0001). A similar correlation with aggressive presentation was seen with the Cognard classification: none (0%) of 40 Type I, one (7%) of 15 Type IIA, three (38%) of eight Type IIB, four (40%) of 10 Type IIA+B, nine (69%) of 13 Type III, 10 (83%) of 12 Type IV, and four (100%) of four Type V (p < 0.0001). No location is immune from harboring lesions capable of an aggressive presentation. Location itself only raises the index of suspicion for dangerous venous anatomy in some intracranial dural AVFs. The configuration of venous anatomy as reflected by both the Cognard and Borden classifications strongly predicts intracranial dural AVFs that will present with ICH or nonhemorrhagic neurological deficit.

scholarly journals Cerebral Diagnostic and Therapeutic Angiography for Neonatal Arteriovenous Fistulas

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 39-42 ◽  
Author(s):  
M. Komiyama ◽  
Y. Honnda ◽  
Y. Matsusaka ◽  
T. Morikawa ◽  
S. Kitano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Neonatal Period ◽  
Severe Congestive Heart Failure ◽  
Vein Of Galen ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cervical Approach

Cerebral diagnostic and therapeutic angiography for neonatal arteriovenous fistulas is reported. Three neonatal boys with vein of Galen aneurysmal malformation (1 patient) and dural arteriovenous fistulas (2 patients) presented severe congestive heart failure soon after birth, and were treated by transarterial and/or transvenous embolization using various access routes. In the neonatal period, umbilical approach and direct cervical approach provide unique access routes in addition to the usual transfemoral route. Characteristics of neonatal angiography are discussed.

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