Radiological and clinical features of vein of Galen malformations.
BACKGROUND
Vein of Galen malformations (VOGMs) are rare and complex congenital arteriovenous fistulas. The clinical and radiological features of VOGMs and their relation to clinical outcomes are not fully characterized.


OBJECTIVE
To examine the clinical and radiological features of VOGMs and the predictors of outcome in patients.


METHODS
We retrospectively reviewed the available imaging and medical records of all patients with VOGMs treated at the University of California, San Francisco between 1986 and 2013. Radiological and clinical features were identified. We applied the modified Rankin Scale to determine functional outcome by chart review. Predictors of outcome were assessed by χ(2) analyses.


RESULTS
Forty-one cases were confirmed as VOGM. Most patients (78%) had been diagnosed with VOGM in the first year of life. Age at treatment was bimodally distributed, with predominantly urgent embolization at <10 days of age and elective embolization after 1 year of age. Patients commonly presented with hydrocephalus (65.9%) and congestive heart failure (61.0%). Mixed-type (31.7%) VOGM was more common in our cohort than purely mural (29.3%) or choroidal (26.8%) types. The most common feeding arteries were the choroidal and posterior cerebral arteries. Transarterial embolization with coils was the most common technique used to treat VOGMs at our institution. Functional outcome was normal or only mildly disabled in 50% of the cases at last follow-up (median=3 years, range=0-23 years). Younger age at first diagnosis, congestive heart failure, and seizures were predictive of adverse clinical outcome. The survival rate in our sample was 78.0% and complete thrombosis of the VOGM was achieved in 62.5% of patients.


CONCLUSIONS
VOGMs continue to be challenging to treat and manage. Nonetheless, endovascular approaches to treatment are continuing to be refined and improved, with increasing success. The neurodevelopmental outcomes of affected children whose VOGMs are treated may be good in many cases.
School of Medicine, University of California, San Francisco Medical School, San Francisco, California, USA.
Maggie L
ML
Chow
Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA.
Daniel L
DL
Cooke
Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, California, USA.
Heather J
HJ
Fullerton
Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA.
Matthew R
MR
Amans
Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA.
Jared
J
Narvid
Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA.
Christopher F
CF
Dowd
Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA.
Randall T
RT
Higashida
Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA.
Van V
VV
Halbach
Department of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California, USA.
Steven W
SW
Hetts
D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D054080:Vein of Galen Malformations / Q000150:complications / Q000473:pathology / Q000628:therapy
Angiography; Arteriovenous Malformation; Intervention; Pediatrics