Transarterial embolization of vein of Galen aneurysmal malformation after unsuccessful stereotactic radiosurgery. Report of three cases

Childs Nerv Syst. 1995 Jul;11(7):406-8. doi: 10.1007/BF00717406.

Abstract

The authors present three cases of vein of Galen aneurysmal malformations (VGAMs) diagnosed in infancy and submitted by the referring teams for stereotactic radiosurgery as the initial therapy (therapeutic doses ranging between 20-25 Gy and 40-50 Gy to the peak dose). After the conventional follow-up of 18-24 months, no change could be detected in the angioarchitecture of the lesions. All three cases were then referred for endovascular treatment and underwent embolization by the transarterial route using liquid adhesives (N-butyl cyanoacrylate). This resulted in complete anatomical exclusion of the lesion. Regardless of the theoretical efficiency of radiosurgery in the management of brain arteriovenous malformations, the present authors believe that transarterial embolization remains the treatment of choice in VGAMs. It offers a high rate of morphological cure and the best chances for normal neurocognitive development. The time required by radiosurgery to achieve a significant result is too long for developing and maturing brain and may not prevent the negative effects of the lesion, mainly in regard to hemo- and hydrodynamic disorders (atrophy, subcortical calcifications, etc.) created by the VGAM, thus leading to irreversible mental retardation.

Publication types

  • Case Reports

MeSH terms

  • Cerebral Angiography
  • Cerebral Veins / abnormalities*
  • Cerebral Veins / diagnostic imaging
  • Cerebral Veins / surgery
  • Child, Preschool
  • Combined Modality Therapy
  • Embolization, Therapeutic*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Intelligence / physiology
  • Intracranial Arteriovenous Malformations / diagnostic imaging
  • Intracranial Arteriovenous Malformations / therapy*
  • Neurologic Examination
  • Neuropsychological Tests
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / therapy*
  • Radiosurgery*