脳障害と治療

概要

Radiological and Clinical Features of Vein of Galen Aneurysmal Malformation in Newborn Infants and, the Results of Endovascular Interventional Treatment: 10-Years Experience

Sinan Tufekci, Zeynep Ince, Beril Yasa, Meltem Bor, Mehmet Barburoglu, Serra Sencer, and Asuman Coban

Aim: To assess the clinical features, diagnosis, treatment and prognosis of newborn infants with a diagnosis of Vein of Galen Malformation (VGAM)during a 10-year period.

Method: Eight patients with a diagnosis of VGAM in the neonatal period were assessed retrospectively in terms of clinical signs, diagnosis, treatment strategies and follow-up. Three of four patients who survived had neurological assessment whereas one was lost to follow-up because of moving to another city.

Results: Seven of 8 patients had an antenatal diagnosis. In all cases, severe heart failure and pulmonary hypertension were present from the first day of life and hypotension, multiorgan failure, hydrocephaly and seizures developed in the following days. VGAM and its feeder arteries were mapped by cranial magnetic resonance imaging and magnetic resonance angiography. Transarterial embolization therapy was performed on 7 patients, of whom four babies survived and three babies died, while one patient died before any intervention.

Conclusion: The mortality and morbidity rates of VGAM is high because of its mixed anatomy, pathophysiology and characteristic features leading to severe neurological sequelae in the survivors. Prognosis in high risk neonates can be improved with aggressive medical support and early endovascular embolization therapy.