Endovascular management of vein of Galen aneurysmal malformations. Influence of the normal venous drainage on the choice of a treatment strategy.
BACKGROUND
Vein of Galen arteriovenous malformations (VGAM) are rare intracranial vascular lesions mostly involving young children. Endovascular therapy is the current standard of care. Albeit interventional techniques have greatly reduced the once dismal vital and functional prognoses previously associated with these lesions, the treatment of VGAMs remains a complex therapeutic challenge.


CONCLUSIONS
This article reviews the available endovascular options for VGAM therapy, emphasizing three points that we have identified as critical in our practice for the establishment of a treatment strategy: (1) the importance of the deep cerebral venous anatomy, in particular the existence of normal drainage through the Galenic system in spite of the VGAM; (2) the concept of treatment staging, for arterial as well as for venous interventions; and (3) the definition of a therapeutic goal that can be attained at a reasonable cost in terms of complication risks and functional outcome.
Pearl
Monica
M
Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Gomez
Juan
J
Gregg
Lydia
L
Gailloud
Philippe
P
D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D017410:Practice Guidelines as Topic; D011379:Prognosis; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome; D054080:Vein of Galen Malformations / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*