title: Fistulous-type vein of Galen malformation phantom model for endovascular training and research.
abstract: BACKGROUND
  Vein of Galen malformation (VGM), a high-flow intracranial arteriovenous shunt, is among the most severe neurovascular diseases in childhood. In many cases untreated children die or survive only severely disabled. Endovascular embolization is the preferred treatment.
  
  
  OBJECTIVE
  To develop a simple fistulous-type VGM phantom model for teaching and training of different endovascular treatment methods and to investigate new treatment options and devices.
  
  
  METHODS
  An experimental in vitro pulsatile phantom model was developed imitating a high-flow fistulous-type VGM, which is typical, especially in the neonatal phase. Pressure measurements at different arterial sites were performed before and after closure of the VGM. Closure of the VGM was achieved by coiling using a combined microcatheter-based transvenous and transarterial approach called 'kissing microcatheter technique'.
  
  
  RESULTS
  The behaviour of the phantom model in vitro under fluoroscopy and under angiographic runs was extremely similar to that in in vivo conditions in children. The results showed that intra-arterial pressures changed and increased statistically significantly at all measurement sites after embolization, as in human arteriovenous malformation. We also demonstrated different and complementary visualizations of hemodynamics and angioarchitecture by antegrade and retrograde microcatheter injections.
  
  
  CONCLUSIONS
  Our phantom model behaves like a typical fistulous-type VGM and can be used in vitro for teaching and training and for further research. It offers a new and better understanding of hemodynamics and angioarchitecture in the endovascular management of VGM.
authors: Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.|Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
authors: Dan
authors: D
authors: Meila
authors: Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
authors: Katharina
authors: K
authors: Melber
authors: Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
authors: Dominik
authors: D
authors: Grieb
authors: Department of Orthodontics, University of Mainz, Mainz, Germany.
authors: Collin
authors: C
authors: Jacobs
authors: Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
authors: Heinrich
authors: H
authors: Lanfermann
authors: Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
authors: Friedhelm
authors: F
authors: Brassel
mesh_terms: D001164:Arteriovenous Fistula / Q000473:pathology / Q000601:surgery; D035843:Biomedical Research / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000193:education* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019047:Phantoms, Imaging; D054080:Vein of Galen Malformations / Q000473:pathology* / Q000601:surgery*
keywords: Arteriovenous Malformation; Blood Pressure; Intervention; Pediatrics; Vascular Malformation