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

Al, Amacher; Shillito, John

doi:10.3171/jns.1973.39.1.0089

Cited by 125 publications

(43 citation statements)

References 29 publications

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“…15,20,30,36,49 High mortality and morbidity of microsurgery, exceeding 90% in some studies, has led to the development of endovascular techniques that more effectively and safely treat VGAMs. 2,26,29,43 However, Gamma Knife surgery achieved favorable outcomes in 88.9% of cases for long-term effects, as reported by Payne et al 44 Finally, patients who refused both endovascular and microsurgical treatment, choosing conservative medical management, had a high mortality rate.…”

Section: Discussionmentioning

confidence: 88%

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

Yan¹,

Wen

Gopaul³

et al. 2015

JNS

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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.

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Section: Discussionmentioning

confidence: 88%

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

Yan¹,

Wen

Gopaul³

et al. 2015

JNS

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“…Stenosis or occlusion of a durai venous sinus distal to the stenotic vein is very common [1], but was not evident in this case. The clinical manifestation varies with the age of presentation [2]. In neonates, the most common presentation is congestive cardiac failure occurring soon after birth.…”

Section: Discussionmentioning

confidence: 99%

Aneurysm of the Vein of Galen Successfully Treated by Interventional Neuroradiology

Qurtom

Balasundaram

et al. 1992

Ann Saudi Med

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A two-month old Kuwaiti boy was admitted to our hospital for the first time with difficulties of feeding and tachypnea of two weeks' duration. He was born at term to healthy consanguineous parents. He is one of twins, the other being healthy; two brothers and two sisters are also healthy. Examination at that time revealed a dyspneic baby who was not cyanosed and had a heart rate of 150/min with a respiratory rate of 60/min and with intercostal recessions. No murmurs could be heard. There was significant hepatosplenomegaly, the liver being 4 cm and spleen 3 cm below the costal margin. Chest x-ray revealed cardiomegaly with a cardiothoracic ratio of 70%.Echocardiogram revealed left atrial dilatation. He was given antifailure therapy. He was seen again at the age of six months, at which time the symptoms were less, hepatosplenomegaly became less, and cardiomegaly persisted. An ejection systolic murmur was now heard over the left sternal border. His head was noticed to be increasing in size with a head circumference of 46 cm and a bruit was auscultated over the skull. Cranial ultrasound revealed hydrocephalus and a computed tomographic (CT) brain scan showed dilatation of the subarachnoid spaces over the frontal and anterior parts of temporal lobes. The lateral and third ventricles showed slight dilatation. On the nonenhanced scan, a mass of increased density was present in the left thalamic region extending across the midline, displacing the third ventricle to the right side. After enhancement enlarged and tortuous vertebral and basilar vessels could be seen, the vein of Galen was ectatic and the straight sinus dilated (Figure 1). There were large vessels in both thalamic regions. Angiography confirmed the diagnosis of a high flow AVM situated in the velum interpositum and supplied by large posteromedial chordoidal and thalamoperforating arteries from both sides and draining to an ectatic vein of Galen (Figure 2). The straight and transverse sinuses were dilated but there was no evidence of durai sinus stenosis or further abnormality.\Fig ure 1. CT scan of brain with contrast showing aneurysm of vein of Galen, dilated straight sinus, and ventriculomegaly. Aneurysm of the Vein of Galen Successfully Treated by Interventional Neuroradiology Annals of Saudi Medicine, Vol 12 No. 2; 1992No shunting procedure was performed for the hydrocephalus. At the age of eight months, the right posteromedial choroidal and thalamoperforating branches supplying the AVM were selectively injected using a microcatheter introduced through a guiding catheter in the right femoral artery and the angiomatous vessels supplied from them were ablated using isobutyl-cyanoacrylate (IBCA) (Figures 3 and 4). This was well tolerated and at the age of 12 months a similar procedure was successfully performed on the left posteromedial choroidal supply. After the emobilization, though four vessel angiography showed filling of a few dilated vessels from a left thalamoperforating artery, there was only minimal residual arteriovenous shunting and the intracr...

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“…From a clinical standpoint, patients with AVG manifest rather predictable sets of symptoms according to the age of presentation [15]that fall into four groups according to Amacher and Shillito [16]. Group 1 consists of children that come under medical care because of severe cardiac failure within a few hours or days after birth.…”

Section: Symptoms/presentationmentioning

confidence: 99%

Spontaneous Thrombosis of Vein of Galen Aneurysmal Malformation

1999

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Two cases of aneurysmal malformations of the vein of Galen (AVG) with spontaneous thrombosis are reported. Angiogram and MRI before thrombosis demonstrated AVGs with slow arteriovenous shunts and associated stagnation of contrast in the venous sac secondary to severe outflow restriction. Based on these findings, one patient was managed conservatively, and the other underwent placement of a ventriculoperitoneal shunt. Surveillance of the lesions with subsequent MRIs revealed spontaneous thrombosis of the AVGs with excellent clinical outcomes. Proposed mechanisms of spontaneous thrombosis include slow flow shunts, obstruction of the venous outflow or obstruction of the feeding artery. Similar cases in the literature are reviewed with special emphasis on diagnostic tests, symptomatology, mechanisms of thrombosis and therapeutic options.

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

Cited by 125 publications

References 29 publications

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

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

Aneurysm of the Vein of Galen Successfully Treated by Interventional Neuroradiology

Spontaneous Thrombosis of Vein of Galen Aneurysmal Malformation

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