Endovascular Treatment of Vein of Galen Malformations

Vein of Galen malformations are rare congenital arteriovenous shunts in which multiple arterial feeders drain directly into the dilated median prosencephalic vein. If left untreated, these lesions carry a high risk of cardiac failure, hydrocephalus and neurodevelopmental impairment. Endovascular treatment, principally by transarterial embolization using liquid or particulate agents, has emerged as the standard of care. Contemporary practice emphasises staged occlusion to minimise abrupt haemodynamic shifts, tailoring the timing and extent of embolization to clinical status. Neonates with high‐output cardiac failure often require urgent intervention, whereas infants and older children may undergo elective multistage procedures. Technical refinements—such as microcatheter design, flow‐directed embolic materials and advanced imaging guidance—have improved the precision of vessel access and reduced periprocedural risks. Comprehensive management involves close collaboration between interventional neuroradiologists, paediatric cardiologists and intensive care teams to optimise outcomes. Long‐term follow‐up focuses on neurologic development, cerebral perfusion and the potential need for cerebrospinal fluid diversion in cases of persistent hydrocephalus.

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Endovascular Treatment of Vein of Galen Malformations publication trend

The graph below shows the total number of articles in endovascular treatment of vein of galen malformations across all publications each year (not limited to Nature Index journals).

Technical terms

Endovascular embolization: A minimally invasive procedure in which material is delivered via microcatheter to occlude abnormal vessels.

Vein of Galen malformation: A congenital arteriovenous connection in which arteries drain into the median prosencephalic vein, leading to high‐output shunting.

Hydrocephalus: Accumulation of cerebrospinal fluid in the ventricular system, often secondary to altered venous drainage.

Bicêtre neonatal evaluation score: A scoring system to assess suitability and timing of embolization in neonates, based on cardiac, neurological and respiratory criteria.

Ventriculoperitoneal shunt: A surgical diversion of cerebrospinal fluid from the ventricles to the peritoneal cavity to relieve hydrocephalus.

References

1. Long-Term Outcomes of Endovascular Embolization in a Vein of Galen Aneurysmal Malformation: A Single-Center Experience. Diagnostics (2023).
2. Outcomes of endovascular embolization for Vein of Galen malformations: An individual participant data meta-analysis. Frontiers in Pediatrics (2022).
3. Vein of Galen Aneurysmal Malformations: Updates on Technical Aspects and Functional Outcomes Post-Endovascular Treatment—A Systematic Review and Meta-Analysis. Medicina (2024).