Multimodality Management of Vein of Galen Malformations–An Institutional Experience
| Autor: | Ahmed El-Garci, Engelbert Knosp, Andreas Gruber, Gerhard Bavinzski, Brigitte Gatterbauer, Arthur Hosmann |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Infarction Arteriovenous fistula Gamma knife Radiosurgery 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine medicine Humans Embolization Child Adverse effect Vein Retrospective Studies Embolization Agent business.industry Endovascular Procedures Infant Newborn Infant Multimodal therapy medicine.disease Combined Modality Therapy Embolization Therapeutic Surgery Treatment Outcome medicine.anatomical_structure Child Preschool Vein of Galen Malformations Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 112:e837-e847 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2018.01.172 |
| Popis: | The vein of Galen aneurysmal malformation (VGM) is a rare intracranial arteriovenous fistula with a dramatic manifestation during infancy and 100% mortality without treatment. Therapeutic strategies for VGMs have changed over time as a result of advances in endovascular techniques. We present our experience and multimodality approach within the last 4 decades.A retrospective analysis and angiographic review were performed of patients with VGM between 1975 and 2016 at our institution.Eighteen consecutive patients were identified, including 10 with choroidal and 8 with mural VGMs. In 37 endovascular interventions, a transarterial approach was mostly performed (82.8%). One patient was initially treated surgically and received 2 Gamma Knife treatments after multiple embolizations. The preferred embolization agent was histoacryl for choroidal VGMs and a combination of coils and histoacryl for mural VGMs. Total occlusion was achieved in 87.5% of mural VGMs and 11.1% of choroidal VGMs. Cerebral hemorrhages and infarction occurred only in patients younger than 1 month. At a median follow-up interval of 4.6 years, good outcome was achieved in 53.8% and poor outcome in 46.2%, with an overall mortality of 16.7%. Poor outcome was significantly associated with choroidal-type VGMs, age1 month at first embolization, and incomplete occlusion.Endovascular embolization using a transarterial approach is the therapy of choice. Gamma Knife radiosurgery can be considered as second-line therapy in a multimodal approach. Whereas treatment within the first month of life is associated with the highest mortality and complications, we did not detect any severe adverse events thereafter. |
| Databáze: | OpenAIRE |
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