Free Article: Vein of Galen Malformations in Neonates

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.

Ahead of Print: Microcatheter Neck Bridging and Incorporated Branch Vessel Protection for Coil Embolization of Wide Neck Ruptured Aneurysm: Technical Case Report

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BACKGROUND AND IMPORTANCE: A novel technique in which microcatheter neck bridging of a ruptured wide neck posterior communicating artery aneurysm (PCOM) was performed by intra-aneurysmal catheter navigation into a fetal configuration posterior cerebral artery (PCA) branch vessel arising from the sac.

CLINICAL PRESENTATION: An 88yr old female with a Hunt and Hess grade 1 and Fisher grade 4 subarachnoid hemorrhage (SAH) was identified to have a wide neck PCOM aneurysm and an isolated fetal configuration PCA with origins from the aneurysm sac. Delivery of a bare platinum GDC coil within the aneurysm lumen resulted in persistent coil prolapse into the parent vessel with occlusion of the incorporated vital PCA origin. A microcatheter was then navigated through the aneurysm lumen and into the fetal configuration PCA. This was retained within the PCA with resultant aneurysm neck narrowing and branch vessel protection. A second microcatheter was placed in the aneurysm lumen for coil delivery. Complete aneurysm occlusion with patency of the PCA without coil loop prolapse into the parent vessel was achieved.