title: Vein of Galen aneurysmal malformation: combined transvenous and transarterial method using a "kissing microcatheter technique".
abstract: BACKGROUND
  Vein of Galen aneurysmal malformation (VGAM) is a severe pediatric neurovascular disease. Children often present with congestive heart failure in the neonatal period. In the last decades, endovascular treatment became the first therapeutic option. The purpose of this study is to report our results in the treatment of VGAM with a combined transvenous and transarterial method in the last ten years.
  
  
  METHODS
  In our cohort of 28 patients with VGAM, 22 patients were treated endovascularly between 1992 and 2010. In the last 10 years, a consecutive series of 14 children were treated with a combined transvenous and transarterial method. The therapeutic goal was immediate shunt reduction of the arteriovenous malformation, especially in the neonatal period. Closure of the fistulous connections was achieved by coiling using a combined transvenous and transarterial approach, called "kissing microcatheter technique".
  
  
  RESULTS
  Eight of 14 children presented in the neonatal period with severe congestive heart failure. The other six patients presented between the age of 2 and 17 months. One patient died due to a non-procedural complication in another hospital 2 years after the last treatment. Complete or >90% of angiographically confirmed closure of the malformation was documented in 11 of 14 patients. Normal or near-normal outcome was achieved in 9 of 13 surviving children, a non-favorable outcome was observed in four children. Control of heart failure was achieved in all patients.
  
  
  CONCLUSIONS
  Endovascular treatment of VGAM using a combined transvenous and transarterial method is a safe procedure with a low complication rate. The overall outcome can be improved, especially in the high-risk neonatal group with congestive heart failure.
authors: Department of Radiology and Neuroradiology, Klinikum Duisburg, Zu den Rehwiesen 9, 47055, Duisburg, Germany. dmeila@yahoo.de
authors: Dan
authors: D
authors: Meila
authors: Raphaela
authors: R
authors: Hannak
authors: Axel
authors: A
authors: Feldkamp
authors: Martin
authors: M
authors: Schlunz-Hendann
authors: Andreas
authors: A
authors: Mangold
authors: Collin
authors: C
authors: Jacobs
authors: Karsten
authors: K
authors: Papke
authors: Friedhelm
authors: F
authors: Brassel
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002550:Cerebral Veins / Q000002:abnormalities*; D003287:Contrast Media / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide