Abstract
Purpose and methods
Superselective transvenous embolization (TVE) with liquid embolic agents is a new concept in treatment of vein of Galen aneurysmal malformations (VGAM). We performed ten sessions of TVE in VGAM patients with restricted transarterial access. In this paper, we assessed clinical and angiographic outcomes of the proposed treatment and discussed three different TVE techniques with regard to morphology of the shunt and outflow tract. Safety and avoidance-of-complication tips were also discussed.
Results
Patient age ranged from 4 to 51 months. There were eight patients with choroidal VGAMs, seven of them were successfully treated with Onyx, and in one case, transvenous catheterization failed. In three cases, adjunctive coiling of draining vein was performed. In three cases, normal deep cerebral veins were connected to the outflow part of malformation; they were preserved during embolization in all cases. Six-month follow-up angiography demonstrated angiographic cure in six cases, and partial occlusion in one.
There were two patients with mural VGAMs: both were treated with n-BCA. Partial occlusion was achieved in both cases.
There was no procedure-related permanent morbidity or mortality. Oculomotor deficit due to quadrigeminal ischemia occurred in one case, and resolved completely after 3 weeks.
Conclusion
TVE with liquid embolic agents is a safe and effective salvage method for VGAMs with restricted transarterial access, previously considered as poor candidates for endovascular treatment.
Similar content being viewed by others
References
Recinos PF, Rahmathulla G, Pearl M, Recinos VR, Jallo GI, Gailloud P, Ahn ES (2012) Vein of Galen malformations: epidemiology, clinical presentations, management. Neurosurg Clin N Am 23(1):165–177
Lasjaunias PL, Chng SM, Sachet M, Alvarez H, Rodesch G, Garcia-Monaco R (2006) The management of vein of Galen aneurysmal malformations. Neurosurgery 59(5 Suppl 3):S184–S194 discussion S3-13
Yan J, Wen J, Gopaul R, Zhang CY, Xiao SW (2015) Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis. J Neurosurg 123(4):872–890
Khullar D, Andeejani AM, Bulsara KR (2010) Evolution of treatment options for vein of Galen malformations. J Neurosurg Pediatr 6(5):444–451
Meila D, Hannak R, Feldkamp A, Schlunz-Hendann M, Mangold A, Jacobs C, Papke K, Brassel F (2012) Vein of Galen aneurysmal malformation: combined transvenous and transarterial method using a “kissing microcatheter technique”. Neuroradiology 54(1):51–59
Dowd CF, Halbach VV, Barnwell SL, Higashida RT, Edwards MS, Hieshima GB (1990) Transfemoral venous embolization of vein of Galen malformations. AJNR Am J Neuroradiol 11(4):643–648
Albuquerque FC, Ducruet AF, Crowley RW, Bristol RE, Ahmed A, McDougall CG (2014) Transvenous to arterial Onyx embolization. J Neurointerv Surg 6(4):281–285
Agarwal H, Sebastian LJ, Gaikwad SB, Garg A, Mishra NK (2017) Vein of Galen aneurysmal malformation-clinical and angiographic spectrum with management perspective: an institutional experience. J Neurointerv Surg 9(2):159–164
Jagadeesan BD, Zacharatos H, Nascene DR, Grande AW, Guillaume DJ, Tummala RP (2016) Endovascular management of a vein of Galen aneurysmal malformation in an infant with challenging femoral arterial access. J Neurosurg Pediatr 18(2):231–234
Alvarez H, Garcia Monaco R, Rodesch G, Sachet M, Krings T, Lasjaunias P (2007) Vein of Galen aneurysmal malformations. Neuroimaging Clin N Am 17(2):189–206
Moon JH, Cho WS, Kang HS, Kim JE, Lee SJ, Han MH (2011) Vein of Galen aneurysmal malformation: endovascular management of 6 cases in a single institute. J Korean Neurosurg Soc 50(3):191–194
Mendes GA, Iosif C, Silveira EP, Waihrich E, Saleme S, Mounayer C (2016) Transvenous embolization in pediatric plexiform arteriovenous malformations. Neurosurgery 78(3):458–465
Crowley RW, Ducruet AF, Kalani MY, Kim LJ, Albuquerque FC, McDougall CG (2015) Neurological morbidity and mortality associated with the endovascular treatment of cerebral arteriovenous malformations before and during the Onyx era. J Neurosurg 122(6):1492–1497
Gross BA, Albuquerque FC, Moon K, McDougall CG (2016) Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas. J Neurosurg 2:1–10
Elsenousi A, Aletich VA, Alaraj A (2016) Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx: a meta-analysis. J Neurointerv Surg 8(3):265–272
Casasco A, Lylyk P, Hodes JE, Kohan G, Aymard A, Merland JJ (1991) Percutaneous transvenous catheterization and embolization of vein of Galen aneurysms. Neurosurgery 28:260–266
Lylyk P, Viñuela F, Dion JE, Duckwiler G, Guglielmi G, Peacock W, Martin N (1993) Therapeutic alternatives for vein of Galen vascular malformations. J Neurosurg 3:438–445
Levrier O, Gailloud PH, Souei M, Manera L, Brunel H, Raybaud C (2004) Normal galenic drainage of the deep cerebral venous system in two cases of vein of Galen aneurysmal malformation. Childs Nerv Syst 20(2):91–97
Rangel-Castilla L, Spetzler RF, Nakaji P (2015) Normal perfusion pressure breakthrough theory: a reappraisal after 35 years. Neurosurg Rev 38(3):399–404 discussion 404-5
Jankowitz BT, Vora N, Jovin T, Horowitz M (2008) Treatment of pediatric intracranial vascular malformations using Onyx-18. J Neurosurg Pediatr 2(3):171–176
Elijovich L, Choudhri AF, Arthur AS, Klimo P, Boop FA, Berenstein A (2016) Retreatment of a choroidal vein of Galen malformation with embolization 42 years after open surgical treatment in the neonatal period. BMJ Case Rep 4:2016
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
After approval by an institutional review board, clinical records and cross-sectional and angiographic data of those patients were retrospectively evaluated.
Conflict of interest
Dr. Orlov is a proctor and consultant for Medtronic in Russian Federation and Commonwealth of Independent States. Other authors have no conflict of interest to declare.
Rights and permissions
About this article
Cite this article
Orlov, K., Gorbatykh, A., Berestov, V. et al. Superselective transvenous embolization with Onyx and n-BCA for vein of Galen aneurysmal malformations with restricted transarterial access: safety, efficacy, and technical aspects. Childs Nerv Syst 33, 2003–2010 (2017). https://doi.org/10.1007/s00381-017-3499-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-017-3499-6