Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis

Abstract

V ein of Galen aneurysmal malformations (VGAMs) are cerebral arteriovenous malformations of the choroidal system draining into the vein of Galen forerunner. Although they represent approximately 1% of all intracranial vascular lesions, they account for 30% of vascular malformations in the pediatric age group.7 Endovascular embolization is the first option for VGAMs. 15,20,30,36 obJect There have been many multidisciplinary approaches to the treatment of vein of Galen malformations. Endovascular embolization is the first option for treatment. However, the effects of the treatment remain controversial. The aim of this study is to assess the efficacy and safety of endovascular embolization to treat patients with vein of Galen malformations. methods This paper includes a retrospective analysis of a sample of 667 patients who underwent endovascular embolization to treat vein of Galen malformations. The data were obtained through a literature search of PubMed databases. The authors also evaluate the efficacy and safety of the treatment. Mortality within the follow-up period is analyzed. Pooled estimates of proportions with corresponding 95% CIs were calculated using raw (i.e., untransformed) proportions (PRAW). results In the 34 studies evaluated, neonates accounted for 44% of the sample (95% CI 31%-57%; I 2 = 92.5%), infants accounted for 41% (95% CI 30%-51%; I 2 = 83.3%), and children and adults accounted for 12% (95% CI 7%-16%; I 2 = 52.9%). The meta-analysis revealed that complete occlusion was performed in 57% (95% CI 48%-65%; I 2 = 68.2%) of cases, with partial occlusion in 43% (95% CI 34%-51%; I 2 = 70.7%). The pooled proportion of patients showing a good outcome was 68% (95% CI 61%-76%; I 2 = 77.8%), while 31% showed a poor outcome (95% CI 24%-38%; I 2 = 75.6%). The proportional meta-analysis showed that postembolization mortality and complications were reported in 10% (95% CI 8%-12%; I 2 = 42.8%) and 37% (95% CI 29%-45%; I 2 = 79.1%), respectively. Complications included cerebral hemorrhage, cerebral ischemia, hydrocephalus, leg ischemia, and vessel perforation. coNclusioNs The successful treatment of vein of Galen malformations remains a complex therapeutic challenge. The authors' analysis of clinical history and research literature suggests that vein of Galen malformations treated with endovascular embolization can result in an acceptable mortality rate, complications, and good clinical outcome. Future large-scale, multicenter, randomized trials are necessary to confirm these findings.

The natural progression of VGAMs and the need for urgent medical attention: a systematic review and meta-analysis

“…It is a congenital vascular malformation that is defined by direct and/or indirect arterial feeders flowing into the median prosencephalic vein (MProsV) of Markowski 57. Most papers focus on reviewing the developmental mechanisms, clinical pathophysiology, and the available data for the management and outcome of the disease,58–61 which were included our previous study 62. However, they did not use pooled data for the key parameters, until in 2010 Khullar et al 63 carried out a structured literature review, pooled the data, and found that 72% of the patients receiving endovascular therapy had a favorable outcome, and the mortality rate was 15%.…”

Sinus Thrombosis after Endovascular Treatment of Vein of Galen Aneurysmal Malformation

“…In fact, total obliteration is not necessary as a reduction of one-third to half of the shunt is usually sufficient to achieve clinical improvement [1,2] . The main complications of this therapy were described by Yan et al [18] in a meta-analysis evaluating 667 patients, included cerebral hemorrhage, cerebral ischemia, hydrocephalus, leg ischemia, and vessel perforation. However, anterograde thrombosis was not cited.…”

A review of extraaxial developmental venous anomalies of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, venous varices or aneurysmal malformations, and enlarged emissary veins

“…The shunting associated with VGAMs is associated with high-output cardiac failure during the neonatal period. 61,75 Symptomatic VGAMs in neonates are nearly always fatal if left untreated. 6 Positive outcomes are most likely to occur if endovascular therapy is initiated in a timely manner, 30,53 as Lasjaunias has emphasized, and a delay may also cause disruption in cerebrospinal fluid flow.…”

“…Endovascular embolization is the current standard of care for the treatment of VGAMs. 31,33,46,75 While transvenous coil embolization, glue embolization, and the combination of the two are becoming popular treatment options, transarterial embolization is often preferred. 53 The goal of endovascular therapy is to occlude the vessels that supply the arteriovenous shunt or to embolize vessels that drain the lesion itself.…”