Abstract
Background Neonatal presentation of vein of Galen aneurysmal malformations (VGAMs) complicated
by cardiac failure and pulmonary hypertension is frequently associated with a poor
prognosis. Interventional neuroradiology with embolization can offer a chance for
survival, although neurological damage can represent a limitation.
Objective This article determines if aggressive intensive care and drug management of cardiac
failure before urgent embolization can influence morbidity and mortality.
Patients and Methods Twelve infants (7 boys, 5 girls) were diagnosed with symptomatic vein of Galen malformations
in the neonatal period during the period 2000 to 2014. Due to high output cardiac
failure, endovascular treatment was attempted as soon as stabilization was achieved.
Results Endovascular procedures successfully reverted cardiac failure in 5 patients who survived
without significant neurological damage, while in 7 patients the causes of death were
refractory cardiac failure, multiorgan failure, and severe brain damage. Bidimensional
echocardiography assessment was performed at presentation and after early embolization
procedures.
Conclusion Aggressive intensive care approach to heart failure and pulmonary hypertension leading
to early neurointervention results in good survival rates with low morbidity even
in cases of high-risk neonatal VGAM. Combined hemodynamic treatment can improve outcome
in neonates with cardiac failure secondary to VGAM, although there is the risk of
precipitating systemic hypoperfusion and renal failure. A moderate prematurity may
not prevent both interventional approach and good outcome.
Keywords
pediatrics - neuroradiology - vein of Galen malformation - heart failure - intensive
care
