title: Vein of Galen malformations in neonates: new management paradigms for improving outcomes.
abstract: BACKGROUND
  Untreated patients with symptomatic neonatal presentation of vein of Galen aneurismal malformations (VGAMs) carry almost 100% morbidity and mortality. Medical management and endovascular techniques for neonatal treatment have significantly evolved.
  
  
  OBJECTIVE
  To evaluate the clinical and angiographic outcomes of modern management of neonates with refractory heart failure from VGAMs.
  
  
  METHODS
  From 2005 to 2010, 16 neonatal patients with VGAM presented to our institution. Medical care from the prenatal to perinatal stages was undertaken according to specified institutional guidelines. Nine patients with refractory heart failure required neonatal endovascular intervention. All patients were treated by transarterial deposition of n-butyl cyanoacrylate into fistula sites. Short- and long-term angiographic studies and clinical outcomes were reviewed.
  
  
  RESULTS
  Control of heart failure was achieved in 8 patients. One premature baby died shortly after treatment. Long-term angiographic follow-up shows total or near-total angiographic obliteration in all 8 patients. One patient has a mild hemiparesis from treatment. Another has a mild developmental delay. One patient developed a severe seizure disorder and developmental delay. Overall, 66.7% patients have normal neurological development with near-total or total obliteration of the malformation.
  
  
  CONCLUSIONS
  Treatment of refractory heart failure in neonatal VGAM with modern prenatal, neurointensive, neuroanesthetic, and pediatric neuroendovascular care results in significantly improved outcomes with presumed cure and normal neurological development in most.
authors.affiliation: Center for Endovascular Surgery, Hyman Newman Institute for Neurology and Neurosurgery, St. Luke's Roosevelt Hospital Center, New York, New York 10019, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Berenstein
authors.forename: Johanna T
authors.initials: JT
authors.lastname: Fifi
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Niimi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Presti
authors.forename: Rafael
authors.initials: R
authors.lastname: Ortiz
authors.forename: Saadi
authors.initials: S
authors.lastname: Ghatan
authors.forename: Barak
authors.initials: B
authors.lastname: Rosenn
authors.forename: Michelle
authors.initials: M
authors.lastname: Sorscher
authors.forename: Walter
authors.initials: W
authors.lastname: Molofsky
mesh_terms: D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D011859:Radiography; D016896:Treatment Outcome; D054080:Vein of Galen Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D006490:Hemostatics