Endovascular management of a vein of Galen aneurysmal malformation in an infant with challenging femoral arterial access

Jagadeesan, Bharathi; Zacharatos, Haralabos; Nascene, David; Grande, Andrew W.; Guillaume, Daniel; Tummala, Ramachandra P.

doi:10.3171/2016.2.peds15652

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…The 19 articles reviewed included a total of 108 patients. Sixty-seven of these 108 patients (62%) were treated with either transfemoral TVE, transjugular TVE, or with a combination of TAE and TVE approaches 9 11 12 14–22. The remaining 41 (38%) were treated with TTE or a combination of TTE, TVE, or TAE approaches (table 1).…”

Section: Resultsmentioning

confidence: 99%

Evolution of transvenous embolization in vein of Galen malformation: case series and review of the literature

Fifi

Bazil

Matsoukas

et al. 2022

J NeuroIntervent Surg

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BackgroundTreatment 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.ObjectiveTo review the literature on TVE of VOGM and then analyze our practice’s unique experience and evolving treatment strategies over 30 years.MethodsA 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.ResultsTVE 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.ConclusionsTT 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.

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Section: Resultsmentioning

confidence: 99%

Evolution of transvenous embolization in vein of Galen malformation: case series and review of the literature

Fifi

Bazil

Matsoukas

et al. 2022

J NeuroIntervent Surg

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“… 3 Nonetheless, embolization of the venous pouch, via either transvenous or transarterial access, can be a successful treatment option. 29 , 30 , 32 It should also be recognized that some patients may not need treatment at all (see illustrative case for type III). Lasjaunias reports spontaneous occlusion of even choroidal VoGMs.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike with type II, the vein was targeted directly in 6 (24%) of 25 patients. [29][30][31][32][33] In four patients (16%), the vein was the initial target. 29,30,33 In two patients, the procedure involved both arterial and venous embolizations.…”

Section: Type Iii: Choroidalmentioning

confidence: 99%

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Vein of Galen malformations in the newborn: case series

Hauck

Yarden

Hauck

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Vein of Galen malformations (VoGMs) in newborns often represent life-threatening emergencies. Outcome is difficult to predict. The authors review 50 VoGM cases to correlate anatomical types with treatment and outcome. OBSERVATIONS Four distinct types of VoGMs are identified: mural simple (type I), mural complex (type II), choroidal (type III), and choroidal with deep venous drainage (type IV). Seven patients presented with mural simple VoGMs with a “single hole” fistula supplied by only one large feeder. These patients were treated electively at >6 months; development was normal. Fifteen patients presented with complex mural VoGMs. Multiple large feeders joined a single fistulous point within the wall of the varix. Patients typically presented with congestive heart failure (CHF) and required emergent transarterial intervention. Mortality was 7.7% with less than two-thirds developing normally. Twenty-five patients presented with choroidal VoGMs. Multiple large arterial feeders joined at multiple fistulous sites. Severe CHF in most patients required emergent transarterial and sometimes transvenous intervention. Mortality was 9.5%; two-thirds of the patients had a normal development. Three babies presented with choroidal VoGMs with deep intraventricular venous drainage. This phenomenon caused fatal “melting brain syndrome” in all three patients. LESSONS Recognition of the specific VoGM type determines treatment options and sets outcome expectations.

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“…By strictly adhering to these technical modifications when using the Scepter XC balloon microcatheter for BAE, we have entirely avoided arterial rupture and balloon microcatheter retention in our patients. The safety of balloon inflation with the Scepter XC balloon in these small vessels is perhaps best illustrated by the successful performance of retrograde transvenous embolization from a pial vein in a 1-year-old with a vein of Galen aneurysmal malformation as reported elsewhere [7]. In our experience, it is safe to carefully inflate the Scepter XC balloon in vessels ≥1.5 mm in diameter, provided this is performed slowly under digital roadmap guidance until the balloon diameter barely matches the vessel diameter.…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Balloon-Assisted Embolization with Onyx of Brain Arteriovenous Malformations Revisited: Personal Experience with the Scepter XC Balloon Microcatheter

2018

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Background/Objective: Compliant dual-lumen balloon microcatheters have been used to perform balloon-assisted embolization (BAE) of brain arteriovenous malformations (AVMs) with ethylene vinyl alcohol copolymer (Onyx). However, vessel rupture and microcatheter retention have been reported from BAE using these microcatheters. Using an extra-compliant balloon microcatheter (Scepter XC; Microvention, Tustin, CA, USA) could help avoid pial vessel rupture during BAE. We herein report our experience using this balloon microcatheter for BAE. Methods: This retrospective study included patients who underwent BAE of brain AVMs at our institution between June 2012 and March 2017. Results: The extra-compliant Scepter XC balloon microcatheter was used for BAE of brain AVMs in 23 patients aged 44.3 ± 16.7 years (range 0–65 years). A total of 40 intracranial vessels (39 pial arteries and 1 pial vein) were catheterized and embolized during 30 separate sessions. In all instances, the balloon microcatheter could be successfully advanced to the AVM nidus. A mean volume of 2.4 ± 1.7 mL (range 0.65–4.6 mL) of Onyx was injected per session. There were no instances of vessel rupture, microcatheter retention, or stroke. Conclusion: Utilization of the extra-compliant balloon microcatheter results in safe and effective BAE, which adds to the growing experience with BAE for AVM treatment.

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Endovascular management of a vein of Galen aneurysmal malformation in an infant with challenging femoral arterial access

Cited by 7 publications

References 9 publications

Evolution of transvenous embolization in vein of Galen malformation: case series and review of the literature

Evolution of transvenous embolization in vein of Galen malformation: case series and review of the literature

Vein of Galen malformations in the newborn: case series

Safety and Feasibility of Balloon-Assisted Embolization with Onyx of Brain Arteriovenous Malformations Revisited: Personal Experience with the Scepter XC Balloon Microcatheter

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