Curative embolization of a vein of Galen malformation with a dual-lumen balloon and ethylene vinyl alcohol copolymer

Luís Henrique De Castro-Afonso,Daniel Giansante Abud

doi:10.46900/apn.v3i2(may-august).82

Luís Henrique De Castro-Afonso, Daniel Giansante Abud

Open Access

https://doi.org/10.46900/apn.v3i2(may-august).82

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Abstract

The endovascular approach is the standard treatment of vein of Galen malformations (VOGMs,) however the morbidity and mortality rates of VOGMs treated by embolization are still significant. Embolization with ethylene vinyl alcohol copolymer (EVOH) by a dual-lumen balloon (DLB) is a promising. In the present case we demonstrated two strategies of transarterial (TA) embolization of a mural type VOGM presenting with two direct shunts. The first shunt was embolized using coils to reduce the flow through the shunt, following by an EVOH injection which resulted in the complete occlusion of that shunt. The second shunt was embolized also with EVOH but through a DLB. In the second embolization a very precise cast of EVOH could be created resulting in a complete occlusion of the VOGM. This case demonstrated the advantages of DLB compared to other embolization techniques

Highlights

Vein of Galen malformations (VOGMs) are rare congenital cerebrovascular conditions
VOGMs, more than seven hundred patients with VOGM treated by embolization were reported in the literature [1, 2]
Of all patients with VOGM treated in the literature 44% were newborns (< 1 month), 41% infants (> 1 months and < 2 years) and only 12% children (> 2 years) or adults

Summary

Introduction

Vein of Galen malformations (VOGMs) are rare congenital cerebrovascular conditions. VGOMs represents around 1% of all intracranial vascular lesions in the general population, while account for 30% of the intracranial vascular malformations in the pediatric population [1, 2]. The reasons for the relatively high rates of poor outcomes of VOGMs are associated with the clinical severity of patients at presentation, and with technical issues related to the treatment [1,2,3]. Embolization with ethylene vinyl alcohol copolymer (EVOH) by a dual-lumen balloon (DLB) is a promising strategy.

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