Fuentes-Redondo Talía, Navia-Álvarez Pedro, Arráez-Aybar Luis-Alfonso
Department of Pediatrics, Complejo Hospitalario de Toledo, 45007 Toledo, Spain.
Unit of Neuroradiology, La Paz University Hospital, 28046 Madrid, Spain.
Medicina (Kaunas). 2024 Nov 26;60(12):1948. doi: 10.3390/medicina60121948.
: Vein of Galen aneurysmal malformations (VGAMs) represent the most common vascular malformations of the brain at the pediatric age. Comprehension of its angioarchitecture and clinical features may influence their treatment options and functional outcomes. The aim of this review is to give an update of the anatomical and technical aspects of the management of VGAMs after endovascular treatment. : We conducted a systematic review of original articles published between 1 January 2014 and 1 February 2024 in Pubmed, Web of Science (WOS), and Scopus databases following PRISMA guidelines. Variables such as age, sex, angioarchitecture of the malformation, clinical presentation, embolization technique, rate of occlusion, post-procedural complications, follow-up time, and mortality were collected. Random-effect meta-analysis of proportions was performed. : Fifteen studies on a total of 400 patients with VGAMs were collected. A total of 65.1% was male. The age at diagnosis was 12% prenatal, 35.5% neonates, 34.1% infants, 15.1% children, and 3.3% adults. Clinical presentation included 31.4% increased head size, 25.7% congestive heart failure, 12.9% neurological deficits, 10% seizures, 9.3% prominence of facial veins, and 8.9% developmental delay. A total of 339 patients underwent endovascular treatment (84.8%) with an average of 2.1 procedures per patient. The embolization technique was defined by transarterial access and glue material. Radiological occlusion was complete in 62.3% of the patients. The most frequent periprocedural incidents included hemorrhagic events (28.4%), embolization material migration (25.7%), and death (22%). The functional outcome was good in 68% of the surviving patients. The average follow-up time was 43.18 months. High heterogeneity was found in all outcomes but mortality rate. : The angioarchitecture of VGAMs is significantly important when planning endovascular treatment and may have an influence on functional outcomes. More research into endovascular techniques and the risks of periprocedural complications must be performed. Indeed, a homogeneous protocol for the assessment of surviving VGAM patients during follow-up is necessary.
大脑大静脉动脉瘤样畸形（VGAMs）是小儿时期最常见的脑部血管畸形。了解其血管构筑和临床特征可能会影响其治疗方案和功能预后。本综述的目的是更新血管内治疗后VGAMs管理的解剖学和技术方面的内容。
我们按照PRISMA指南，对2014年1月1日至2024年2月1日期间在Pubmed、科学网（WOS）和Scopus数据库中发表的原始文章进行了系统综述。收集了年龄、性别、畸形的血管构筑、临床表现、栓塞技术、闭塞率、术后并发症、随访时间和死亡率等变量。进行了比例的随机效应荟萃分析。
共收集了15项关于400例VGAMs患者的研究。男性占65.1%。诊断时的年龄分布为12%为产前，35.5%为新生儿，34.1%为婴儿，15.1%为儿童，3.3%为成人。临床表现包括31.4%头围增大，25.7%充血性心力衰竭，12.9%神经功能缺损，10%癫痫发作，9.3%面部静脉突出，8.9%发育迟缓。共有339例患者接受了血管内治疗（84.8%），平均每位患者进行2.1次手术。栓塞技术由经动脉入路和胶水材料定义。62.3%的患者实现了放射学上的完全闭塞。最常见的围手术期事件包括出血事件（28.4%）、栓塞材料迁移（25.7%）和死亡（22%）。68%的存活患者功能预后良好。平均随访时间为43.18个月。除死亡率外，所有结局均发现高度异质性。
在规划血管内治疗时，VGAMs的血管构筑非常重要，可能会对功能预后产生影响。必须对血管内技术和围手术期并发症的风险进行更多研究。确实，有必要制定一个统一的方案来评估随访期间存活的VGAM患者。
