MANAGEMENT OF THE VEIN OF GALEN ANEURYSMAL MALFORMATION CASES PRESENTING IN THE NEONATAL PERIOD

Öz

Objective: Vein of Galen aneurysmal malformations (VGAM) are rare congenital vascular anomalies with challenging management, especially in neonates with severe hemodynamic compromise. This study evaluated outcomes of neonatal VGAM treated with endovascular embolization at a single center.

Materials and Methods: We retrospectively analysed 14 patients diagnosed antenatally or symptomatic within 28 days, managed between 2005 and 2025. Data included demographics, clinical and cardiac status, imaging, Bicêtre scores, treatment, and outcomes. Per protocol, embolization followed cardiopulmonary stabilization and could occur beyond the neonatal period.

Results: Of the 14 neonates, 12 (85.7%) underwent embolization, while two (14.3%) died before intervention due to poor general condition. The mean gestational age was 38.8±1.0 weeks, and the mean birth weight was 3,283±292 g. The majority of the cases (66.7%) were classified as mixed-type VGAM. The mean Bicêtre score was 11.0±3.9. Embolization was performed at a mean of 176±149 postnatal days, requiring an average of 2.1 sessions per patient. Pulmonary hypertension and cardiomegaly were the most frequent cardiac findings (75% and 58.3%, respectively). The embolic agents included were n-butyl cyanoacrylate (NBCA) and ethylene vinyl alcohol copolymer (EVA). The mortality rate among embolized patients was 33.3%. Survivors exhibited normal neurodevelopment in 75% of the cases.

Conclusion: Endovascular embolization is a viable strategy for VGAM cases presenting in the neonatal period, although mortality remains substantial in patients with severe cardiac compromise. Early diagnosis, multidisciplinary management, and long-term follow-up are essential for optimizing survival and neurological outcomes.

Anahtar Kelimeler

• Vein of Galen malformation
• Neonate
• Endovascular treatment
• Hydrocephalus
• Heart failure

Kaynakça

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