title: Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis.
abstract: OBJECTIVE
  There have been many multidisciplinary approaches to the treatment of vein of Galen malformations. Endovascular embolization is the first option for treatment. However, the effects of the treatment remain controversial. The aim of this study is to assess the efficacy and safety of endovascular embolization to treat patients with vein of Galen malformations.
  
  
  METHODS
  This paper includes a retrospective analysis of a sample of 667 patients who underwent endovascular embolization to treat vein of Galen malformations. The data were obtained through a literature search of PubMed databases. The authors also evaluate the efficacy and safety of the treatment. Mortality within the follow-up period is analyzed. Pooled estimates of proportions with corresponding 95% CIs were calculated using raw (i.e., untransformed) proportions (PRAW).
  
  
  RESULTS
  In the 34 studies evaluated, neonates accounted for 44% of the sample (95% CI 31%-57%; I(2) = 92.5%), infants accounted for 41% (95% CI 30%-51%; I(2) = 83.3%), and children and adults accounted for 12% (95% CI 7%-16%; I(2) = 52.9%). The meta-analysis revealed that complete occlusion was performed in 57% (95% CI 48%-65%; I(2) = 68.2%) of cases, with partial occlusion in 43% (95% CI 34%-51%; I(2) = 70.7%). The pooled proportion of patients showing a good outcome was 68% (95% CI 61%-76%; I(2) = 77.8%), while 31% showed a poor outcome (95% CI 24%-38%; I(2) = 75.6%). The proportional meta-analysis showed that postembolization mortality and complications were reported in 10% (95% CI 8%-12%; I(2) = 42.8%) and 37% (95% CI 29%-45%; I(2) = 79.1%), respectively. Complications included cerebral hemorrhage, cerebral ischemia, hydrocephalus, leg ischemia, and vessel perforation.
  
  
  CONCLUSIONS
  The successful treatment of vein of Galen malformations remains a complex therapeutic challenge. The authors' analysis of clinical history and research literature suggests that vein of Galen malformations treated with endovascular embolization can result in an acceptable mortality rate, complications, and good clinical outcome. Future large-scale, multicenter, randomized trials are necessary to confirm these findings.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Jun
authors.initials: J
authors.lastname: Yan
authors.affiliation: Rheumatism, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wen
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Roodrajeetsing
authors.initials: R
authors.lastname: Gopaul
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Zhang
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Shao-wen
authors.initials: SW
authors.lastname: Xiao
mesh_terms: D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D016896:Treatment Outcome; D054080:Vein of Galen Malformations / Q000628:therapy*
keywords: DSA = digital subtraction angiography; VGAM = vein of Galen aneurysmal malformation; complications; endovascular embolization; meta-analysis; outcome; vascular disorders; vascular malformations; vein of Galen malformation