Occlusion of a mural type vein of Galen malformation in a 10-month-old boy with three Woven EndoBridge (WEB 17) and two coils

Abstract

We report the case of a 10-month-old boy with an enlarged head circumference and severe motor developmental delay. MRI showed a vein of Galen malformation (VGAM) with a heavily dilated median prosencephalic vein. Digital subtraction angiography confirmed a mural type VGAM with three feeding arteries arising from the posterior cerebral arteries. Due to the short length of the feeding arteries and the high flow, occlusion of the feeding vessels with detachable coils was not possible because of repeated coil dislocation into the dilated vein. Embolization of the three feeding vessels was then performed with a Woven EndoBridge single layer device (WEB SL17). In two arteries complete occlusion was accomplished with the WEB alone and in one artery additional deployment of two coils was necessary. Follow-up imaging at day 1 after treatment as well as 3 and 9 months after embolization showed persistent occlusion.

Vein of Galen malformations in the newborn: case series

“…10 The other six patients underwent elective embolization several months after birth. [11][12][13][14][15] Median age at treatment was 32 weeks (range 1-24 weeks). Typical reason for treatment was growth of the lesion during the first 6 months of life.…”

“…All patients survived (100%), and no adverse outcomes (0%) were reported. [10][11][12][13][14][15] Illustrative Case Three weeks prior to delivery, a VoGM had been diagnosed in a 2.5-kg full-term boy who was delivered at our institution. His echocardiogram and brain magnetic resonance imaging (MRI) were normal, except for the VoGM.…”

“…Treatment included embolization of the large, single feeding artery, preferably with high-concentration n -butyl cyanoacrylate (NBCA). 11 Other options included coils, 15 WEB (Microvention), 14 and the MVP Amplatzer device (Medtronic). All patients survived (100%), and no adverse outcomes (0%) were reported.…”