Devarajan Alex, Goldman Daryl, Bonet Jessica, Philbrick Brandon D, Deuschl Cornelius, Yamac Elif, Ayad Ahmed, Tabani Halima, Sorscher Michelle, Berenstein Alejandro, Fifi Johanna T, Chapot René, Shigematsu Tomoyoshi
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Interv Neuroradiol. 2024 Oct 3:15910199241282719. doi: 10.1177/15910199241282719.
Vein of Galen malformations are congenital arteriovenous malformations primarily treated by endovascular embolization via transarterial or transvenous approaches. transvenous embolization can be utilized to close the malformation but may be difficult in patients with venous stenosis or blockages, which drive venous hypertension and lead to significant neurologic consequences. Here, we illustrate the atypical placement of an intracranial venous sinus stent to improve outflow after transvenous embolization in pediatric patients with the vein of Galen malformation.
A retrospective review of clinical databases at two high-volume endovascular centers from January 2018 to March 2023 identified all vein of Galen malformation patients who received a venous sinus stent during transvenous embolization. Clinical data, imaging, angioarchitecture, operative details, postoperative management, and follow-up were reviewed.
Three patients presented for transvenous embolization after multiple staged transarterial embolizations of their vein of Galen malformation. Transvenous access was complicated by lateral sinus stenosis, which was temporarily relieved by balloon angioplasty. After transvenous embolization by pressure cooker technique, the dural sinuses were stented using the existing venous guide catheter. Venous angiography demonstrated improved flow across the stenosed areas and post-embolization angiography demonstrated normalized venous drainage with widely patent stents. One patient experienced postoperative oculomotor nerve palsy unrelated to the stent placement. All patients demonstrated a complete cure of their vein of Galen malformations with patent venous sinus stents on follow-up.
In patients with the vein of Galen malformation and venous hypertension receiving transvenous embolization, venous sinus stenting may be a safe and effective option to reduce aberrant cortical venous drainage and improve normal outflow. Further studies are warranted to investigate its benefit in high-flow vascular malformations.
大脑大静脉畸形是先天性动静脉畸形，主要通过经动脉或经静脉途径进行血管内栓塞治疗。经静脉栓塞可用于闭合畸形，但对于存在静脉狭窄或阻塞的患者可能具有挑战性，这些情况会导致静脉高压并引发严重的神经后果。在此，我们展示了在患有大脑大静脉畸形的儿科患者经静脉栓塞后，颅内静脉窦支架的非典型放置以改善血流流出。
对2018年1月至2023年3月期间两个高容量血管内治疗中心的临床数据库进行回顾性分析，确定了所有在经静脉栓塞期间接受静脉窦支架置入的大脑大静脉畸形患者。对临床数据、影像学、血管结构、手术细节、术后管理及随访情况进行了回顾。
3例患者在多次分期经动脉栓塞大脑大静脉畸形后接受经静脉栓塞治疗。经静脉入路因外侧窦狭窄而复杂化，通过球囊血管成形术暂时缓解。采用高压锅技术经静脉栓塞后，利用现有的静脉引导导管对硬脑膜窦进行支架置入。静脉血管造影显示狭窄区域血流改善，栓塞后血管造影显示静脉引流正常，支架广泛通畅。1例患者出现与支架置入无关的术后动眼神经麻痹。所有患者随访时大脑大静脉畸形均完全治愈，静脉窦支架通畅。
对于接受经静脉栓塞治疗的大脑大静脉畸形且伴有静脉高压的患者，静脉窦支架置入可能是一种安全有效的选择，可减少异常的皮质静脉引流并改善正常血流流出。有必要进一步研究其在高流量血管畸形中的益处。
