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Meta-Analysis
. 2017 Dec;38(12):2308-2314.
doi: 10.3174/ajnr.A5403. Epub 2017 Oct 5.

Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis

W Brinjikji  1   2   3 , T Krings  3 , M H Murad  4 , A Rouchaud  5 , D Meila  6   7
Affiliations
Meta-Analysis

Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis

W Brinjikji et al. AJNR Am J Neuroradiol. 2017 Dec.

Abstract

Background: Outcomes after endovascular embolization of vein of Galen malformations remain relatively poorly described.

Purpose: We performed a systematic review of the literature to determine outcomes and predictors of good outcomes following endovascular treatment of vein of Galen malformations.

Data sources: We used Ovid MEDLINE, Ovid Embase, and the Web of Science.

Study selection: Our study consisted of all case series with ≥4 patients receiving endovascular treatment of vein of Galen malformations published through January 2017.

Data analysis: We studied the following outcomes: complete/near-complete occlusion rates, technical complications, perioperative stroke, perioperative hemorrhage, technical mortality, all-cause mortality, poor neurologic outcomes, and good neurologic outcomes. Outcomes were stratified by age-group (neonate, infant, child). A random-effects meta-analysis was performed.

Data synthesis: A total of 27 series with 578 patients were included; 41.9% of patients were neonates, 45.0% of patients were infants, and 13.1% of patients were children. All-cause mortality was 14.0% (95% CI, 8.0%-22.0%). Overall good neurologic outcome rates were 62.0% (95% CI, 57.0%-67.0%). Overall poor neurologic outcome rates were 21.0% (95% CI, 17.0%-26.0%). Neonates were significantly less likely to have good neurologic outcomes than infants (48.0%; 95% CI, 35.0%-62.0% versus 77.0%; 95% CI, 70.0%-84.0%; P < .01). Treatment indications following the Bicêtre neonatal evaluation score resulted in significantly higher rates of good neurologic outcome (P = .04). Patients with congestive heart failure had significantly lower rates of good neurologic outcome (OR, 0.50; 95% CI, 0.28-0.88; P = .01).

Limitations: Limitations were selection and publication biases.

Conclusions: Patients receiving endovascular embolization of vein of Galen malformations experienced good long-term clinical outcomes in >60% of cases. Appropriate patient selection is key as treatment guided by the Bicêtre neonatal evaluation score was associated with improved neurologic outcomes.

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Figures

Fig 1.
Fig 1.
PRISMA flow diagram.
Fig 2.
Fig 2.
Presentation by age group. HCP indicates hydrocephalus; HC, head circumference; ICH, intracranial hemorrhage; inc, increase.
Fig 3.
Fig 3.
Forest plot for good neurologic outcome.
See this image and copyright information in PMC

References

    1. Raybaud CA, Strother CM, Hald JK. Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation. Neuroradiology 1989;31:109–28 10.1007/BF00698838 - DOI - PubMed
    1. Moon JH, Cho WS, Kang HS, et al. Vein of Galen aneurysmal malformation: endovascular management of 6 cases in a single institute. J Korean Neurosurg Soc 2011;50:191–94 10.3340/jkns.2011.50.3.191 - DOI - PMC - PubMed
    1. Berenstein A, Fifi JT, Niimi Y, et al. Vein of Galen malformations in neonates: new management paradigms for improving outcomes. Neurosurgery 2012;70:1207–13; discussion 13–14 10.1227/NEU.0b013e3182417be3 - DOI - PubMed
    1. Lasjaunias P, Hui F, Zerah M, et al. Cerebral arteriovenous malformations in children: management of 179 consecutive cases and review of the literature. Childs Nerv Syst 1995;11:66–79; discussion 79 10.1007/BF00303807 - DOI - PubMed
    1. Frawley GP, Dargaville PA, Mitchell PJ, et al. Clinical course and medical management of neonates with severe cardiac failure related to vein of Galen malformation. Arch Dis Child Fetal Neonatal Ed 2002;87:F144–49 10.1136/fn.87.2.F144 - DOI - PMC - PubMed

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