Vein of galen malformations in neonates: New management paradigms for improving outcomes

Alex Berenstein, Johanna T. Fifi, Yasunari Niimi, Salvatore Presti, Rafael Ortiz, Saadi Ghatan, Barak Rosenn, Michelle Sorscher, Walter Molofsky

Research output: Contribution to journalReview articlepeer-review

71 Scopus citations


BACKGROUND: Untreated patients with symptomatic neonatal presentation of vein of Galen aneurismal malformations (VGAMs) carry almost 100% morbidity and mortality. Medical management and endovascular techniques for neonatal treatment have significantly evolved. OBJECTIVE: To evaluate the clinical and angiographic outcomes of modern management of neonates with refractory heart failure from VGAMs. METHODS: From 2005 to 2010, 16 neonatal patients with VGAM presented to our institution. Medical care from the prenatal to perinatal stages was undertaken according to specified institutional guidelines. Nine patients with refractory heart failure required neonatal endovascular intervention. All patients were treated by transarterial deposition of n-butyl cyanoacrylate into fistula sites. Short-and long-term angiographic studies and clinical outcomes were reviewed. RESULTS: Control of heart failure was achieved in 8 patients. One premature baby died shortly after treatment. Long-term angiographic follow-up shows total or near-total angiographic obliteration in all 8 patients. One patient has a mild hemiparesis from treatment. Another has a mild developmental delay. One patient developed a severe seizure disorder and developmental delay. Overall, 66.7% patients have normal neurological development with near-total or total obliteration of the malformation. CONCLUSION: Treatment of refractory heart failure in neonatal VGAM with modern prenatal, neurointensive, neuroanesthetic, and pediatric neuroendovascular care results in significantly improved outcomes with presumed cure and normal neurological development in most.

Original languageEnglish
Pages (from-to)1207-1213
Number of pages7
Issue number5
StatePublished - May 2012
Externally publishedYes


  • Congenital malformation
  • Congestive heart failure
  • Intracranial arteriovenous malformation
  • Neonate
  • Therapeutic embolization
  • Vein of Galen aneurismal malformation


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