Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Department of Neurosurgery, Texas Children's Hospital, Houston, Texas.
Oper Neurosurg (Hagerstown). 2019 Sep 1;17(3):286-292. doi: 10.1093/ons/opy369.
Vein of Galen malformations (VOGM) comprise nearly a third of pediatric cerebrovascular anomalies, with potentially devastating neurological and systemic complications. Advances in endovascular therapies have dramatically improved outcomes compared to historical surgical treatments, and neurosurgeons are an essential component of the multidisciplinary critical care team.
To retrospectively review pediatric patients with VOGM treated at Texas Children's Hospital (TCH), a quaternary referral center, over 15 yr, and present lessons learned in treating children with modern endovascular techniques.
Charts from TCH were retrospectively reviewed for the past 15 yr. Patients with diagnosis including "Vein of Galen," "Vein of Galen malformation," "Vein of Galen aneurysmal malformation," or any abbreviations (ie, VOG, VOGM, VOGAM) were reviewed. Presentation, imaging, treatment specifics, and clinical outcomes were reported.
There were 18 patients with VOGM managed at TCH from 2002 to 2018 with a total of 29 embolizations. Seventeen were performed with a single embolisate (NBCA or Onyx), and 12 with a combination. A dual lumen balloon catheter was used as an adjunct in 3 embolizations. Complications occurred in 5 embolizations (24%), including hemorrhage, embolisate migration, and femoral vessel occlusion. Surviving patients were followed for a mean of 38 mo, with 12 having normal or near-normal neurological development.
VOGM can present with a myriad of neurological and systemic symptoms, potentially in extremis. Neurosurgical involvement in these cases is critical, as urgent treatment can be lifesaving. Patients may require multiple treatment sessions using a variety of endovascular tools and techniques.
Galen 静脉畸形（VOGM）占儿科脑血管畸形的近三分之一，可能导致严重的神经和全身并发症。与历史上的手术治疗相比，血管内治疗的进步显著改善了预后，神经外科医生是多学科重症监护团队的重要组成部分。
回顾性分析在德克萨斯儿童医院（TCH）接受治疗的 VOGM 儿科患者，该医院是一家四级转诊中心，介绍应用现代血管内技术治疗儿童患者的经验教训。
对 TCH 过去 15 年的病历进行回顾性分析。患者诊断包括“Galen 静脉”、“Galen 静脉畸形”、“Galen 静脉动脉瘤性畸形”或任何缩写（即 VOG、VOGM、VOGAM）。报告患者的临床表现、影像学表现、治疗细节和临床结果。
2002 年至 2018 年，TCH 共收治 18 例 VOGM 患者，共进行了 29 次栓塞术。17 例采用单一栓塞剂（NBCA 或 Onyx），12 例采用联合治疗。3 例栓塞术使用了双腔球囊导管作为辅助。5 次栓塞术（24%）出现并发症，包括出血、栓塞剂迁移和股血管闭塞。存活患者平均随访 38 个月，12 例患者神经发育正常或接近正常。
VOGM 可表现出多种神经和全身症状，可能处于危急状态。神经外科在这些病例中的参与至关重要，因为紧急治疗可以挽救生命。患者可能需要多次治疗，使用各种血管内工具和技术。
