Vein of galen aneurysmal malformation : endovascular management of 6 cases in a single institute

Abstract

Objective: The aim of this study was to analyze the treatment outcome of patients with vein of Galen aneurysmal malformations (VGM).

Methods: Clinical and angiographic data of six consecutive patients with VGM were retrospectively reviewed. VGMs were angiographically classified by Yasargil's method. Treatment outcomes were evaluated.

Results: Mean age at initial treatment was 4.4±5.7 months. Angiographic types of VGMs were type II in two patients and type III in four. Three patients had cardiac symptoms and the others were asymptomatic. Two patients were treated with transvenous embolization, three with transarterial embolization, and one was managed conservatively. Two patients died due to venous hypertension few days after transvenous approach. Of three patients who were transarterially embolized, one was completely occluded with Onyx and two were incompletely occluded. During the follow-up period (range, one to six years) two of three patients treated with transarterial approach were asymptomatic and the other showed mild symptoms. One patient who was managed conservatively showed normal performance.

Conclusion: Transarterial embolization of VGMs may be better than transvenous approach in terms of the treatment outcome and complication. Further studies are needed because of the rarity of the disease and rapid advancement of endovascular techniques.

Keywords: Endovascular treatment; Transarterial embolization; Transvenous embolization; Vein of Galen aneurysmal malformation.

Fig. 1

A : Brain MR axial imaging. Dilated vein of Galen is observed. B and C : Cerebral angiography. The lesion has multiple direct fistulae from lenticulostriate artery, pericallosal artery, and posterior cerebral artery to the vein of Galen (B). The lesion was embolized with multiple coils via 2 times of transvenous approach (C). D : Brain CT. Diffuse brain swelling and intracranial hemorrhage are observed. MR : magnetic resonance, CT : computed tomography.

Fig. 2

A : Brain sonography. Dilated vein of Galen is observed. B : Cerebral angiography. Vein of Galen is supplied by posterior cerebral artery and pericallosal artery. C : Transarterial embolization with coil and Onyx. First transarterial embolization with coil via posterior cerebral artery at 2 weeks of age and second embolization with Onyx via pericallosal artery at 1 year of age were performed, respectively. D : Follow-up angiography. There is no evidence of remaining shunt.