Baranoski Jacob F, Catapano Joshua S, Albuquerque Felipe C, Abruzzo Todd A
Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ, United States.
Department of Neuroradiology, Phoenix Children's Hospital, Phoenix, AZ, United States.
Front Pediatr. 2023 Mar 23;11:1082318. doi: 10.3389/fped.2023.1082318. eCollection 2023.
Endovascular embolization is the primary strategy in the management for vein of Galen malformations (VOGM). However, despite significant advances in endovascular embolization technologies and techniques, VOGMs remain very technically challenging lesions largely due to the high-flow arteriovenous shunts present in these malformations. A variety of advanced flow-control techniques can be implemented to mitigate the risk of venous escape and increase the safety and efficacy of endovascular treatment. These techniques include regionally targeted strategies (transvenous embolization and balloon-assisted transarterial embolization) and global flow-control methods (pharmacologic cardiac arrest and rapid ventricular overdrive pacing). Each of these strategies are associated with unique advantages and disadvantages, highlighting the importance of a patient-specific approach when treating these challenging lesions.
血管内栓塞是大脑大静脉畸形（VOGM）治疗的主要策略。然而，尽管血管内栓塞技术取得了显著进展，但VOGM在技术上仍然极具挑战性，主要原因是这些畸形中存在高流量动静脉分流。可以采用多种先进的流量控制技术来降低静脉逃逸风险，提高血管内治疗的安全性和有效性。这些技术包括区域靶向策略（经静脉栓塞和球囊辅助经动脉栓塞）和整体流量控制方法（药物性心脏骤停和快速心室超速起搏）。这些策略各自都有独特的优缺点，凸显了在治疗这些具有挑战性的病变时采用个体化方法的重要性。
