The use of adenosine in the treatment of a high-flow vein of Galen malformation in an adult.
The treatment of high-flow vein of Galen aneurysmal malformations (VGAM) remains a therapeutic challenge for the neurosurgeon and the neurointerventionalist, as it is associated with high morbidity and mortality rates despite recent advances in open cranial surgery and interventional neuroradiology. A 37-year-old patient presented with a history of non-specific headaches. He had a history of heart failure since birth that was caused by an untreated VGAM. Intravenous boluses of adenosine were injected as an attempt to slow down the arteriovenous shunting of a VGAM prior to endovascular treatment. Adenosine can be a very useful adjunct in patients with extremely high arteriovenous shunting. n-butyl cyanoacrylate (n-BCA) should be the embolic material of choice due to its quick polymerization and adhesive properties.
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
Asterios
A
Tsimpas
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
Nohra
N
Chalouhi
Rancocas Valley Anesthesia, Cinnaminson, NJ, USA.
Jonathan D
JD
Halevy
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
Stavropoula
S
Tjoumakaris
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
L Fernando
LF
Gonzalez
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
Stephen J
SJ
Monteith
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
Aaron S
AS
Dumont
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
Robert
R
Rosenwasser
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA. Electronic address: pascal.jabbour@jefferson.edu.
Pascal
P
Jabbour
D000241:Adenosine / Q000627:therapeutic use*; D000328:Adult; D015901:Angiography, Digital Subtraction; D006801:Humans; D008297:Male; D014665:Vasodilator Agents / Q000627:therapeutic use*; D054080:Vein of Galen Malformations / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
D014665:Vasodilator Agents; D000241:Adenosine
Adenosine; Endovascular therapy; Flow arrest; High-flow arteriovenous shunt; Vein of Galen aneurysmal malformation