Neonatal vein of Galen malformations: experience in developing a multidisciplinary approach using an embolization treatment protocol.
A multidisciplinary team approach using a staged transcatheter embolization and neurosurgical protocol was applied to 22 patients with neonatal presentation of vein of Galen malformations over a 12 year period. Aggressive medical therapy was combined with interventions including: ventricular shunting, transcatheter embolization, retrograde transtorcular embolization, and neurosurgical obliteration. There was a high frequency of high output cardiac failure, multiple organ system dysfunction, seizures, hydrocephalus, visual, developmental and neurological disability. Of the first 11 patients, five survived; four with seizures and three with marked retardation. Of the last 11 patients, six survived; five with seizures but only one with retardation. Despite persistently high morbidity and mortality, our continuously evolving protocol offers these otherwise hopeless patients some chance of survival.
Friedman
D M
DM
New York University Medical Center, New York 10016.
Madrid
M
M
Berenstein
A
A
Choi
I S
IS
Wisoff
J H
JH
D002550:Cerebral Veins / Q000002:abnormalities* / Q000601:surgery; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000401:mortality / Q000628:therapy; D008297:Male; D011379:Prognosis; D013997:Time Factors