Document Detail


Predicting factors for the follow-up outcome and management decisions in vein of Galen aneurysmal malformations.
MedLine Citation:
PMID:  19662427     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Vein of Galen aneurysmal malformations (VGAMs) are choroidal arteriovenous malformations that develop during an early embryonic stage. Although recent reports have shown improved outcome for these patients, the overall outcome still is poor. In this study, we evaluated the clinical, imaging, and angiographic features that may predict the outcome in VGAM patients. METHODS: Twenty-five patients diagnosed with VGAM were reviewed for clinical symptoms, including neonatal scoring systems, imaging findings, angioarchitecture, treatment decision, initial treatment age, follow-up timing, and follow-up outcome. RESULTS: Factors that were significantly associated with a poor outcome (p < 0.05) included neurological symptoms at presentation, a medium-to-low overall neonatal score (<12/21), a very poor score (<2/5) in one (or more) categories, focal parenchymal changes, calcifications, tonsillar herniation, arterial steal, or more than two groups of multiple arterial feeders. The venous drainage pattern and treatment age were not significantly associated with the overall outcome. CONCLUSIONS: The presence of multiple factors that are related with poor outcome may warrant withholding aggressive treatment, while a small subgroup of carefully selected patients without any of these factors who are clinically asymptomatic may have a good outcome even with conservative management and close follow-up. For all other patients in which treatment is considered, the optimal treatment time is at 4-5 months of age; however, urgent treatment, regardless of age, should be indicated in those that do not have permanent brain damage on imaging with deteriorating congestive heart failure, evidence of arterial steal, or progressive occlusion of the venous outflow.
Authors:
Sasikhan Geibprasert; Timo Krings; Derek Armstrong; Karel G Terbrugge; Charles A Raybaud
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Publication Detail:
Type:  Journal Article     Date:  2009-08-07
Journal Detail:
Title:  Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery     Volume:  26     ISSN:  1433-0350     ISO Abbreviation:  Childs Nerv Syst     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-11-12     Completed Date:  2010-03-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503227     Medline TA:  Childs Nerv Syst     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  35-46     Citation Subset:  IM    
Affiliation:
Neuroradiology Division, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada, M5G 1X8. sasikhan.geibprasert@sickkids.ca
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Cerebral Angiography
Cerebral Veins / pathology
Cerebrovascular Circulation
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Pregnancy
Prenatal Diagnosis
Prognosis
Severity of Illness Index
Treatment Outcome
Vein of Galen Malformations / diagnosis*,  pathology,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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