<br>Galen 静脉畸形：德克萨斯儿童医院在现代血管内时代的经验。,Operative Neurosurgery

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Galen 静脉畸形：德克萨斯儿童医院在现代血管内时代的经验。
Operative Neurosurgery ( IF 1.7 ) Pub Date : 2019-09-01 , DOI: 10.1093/ons/opy369
Kathryn M Wagner ₁ , Michael G Z Ghali ₁ , Visish M Srinivasan ₁ , Sandi Lam ₂ , Jeremiah Johnson ₁ , Stephen Chen ₃ , Peter Kan ₁

Affiliation

背景盖伦静脉畸形 (VOGM) 占儿童脑血管异常的近三分之一，具有潜在的破坏性神经和全身并发症。与历史上的外科治疗相比，血管内治疗的进步极大地改善了结果，神经外科医生是多学科重症监护团队的重要组成部分。目的回顾性回顾在四级转诊中心德克萨斯儿童医院 (TCH) 治疗超过 15 年的 VOGM 儿科患者，并介绍使用现代血管内技术治疗儿童的经验教训。方法对过去 15 年的 TCH 图表进行回顾性审查。对诊断包括“盖伦静脉”、“盖伦静脉畸形”、“盖伦静脉动脉瘤畸形”或任何缩写（即 VOG、VOGM、VOGAM）的患者进行了审查。报告了表现、影像学、治疗细节和临床结果。结果 2002年至2018年，TCH治疗了18例VOGM患者，总共29个栓塞。 17 例采用单一栓塞（NBCA 或 Onyx），12 例采用组合栓塞。在 3 次栓塞中使用双腔球囊导管作为辅助手段。 5 例栓塞（24%）发生并发症，包括出血、栓塞迁移和股血管闭塞。存活患者平均随访 38 个月，其中 12 名患者神经发育正常或接近正常。结论 VOGM 可能会出现多种神经系统和全身症状，甚至可能出现在极端情况下。这些病例的神经外科介入至关重要，因为紧急治疗可以挽救生命。患者可能需要使用各种血管内工具和技术进行多次治疗。

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Vein of Galen Malformations: The Texas Children's Hospital Experience in the Modern Endovascular Era.

BACKGROUND Vein of Galen malformations (VOGM) comprise nearly a third of pediatric cerebrovascular anomalies, with potentially devastating neurological and systemic complications. Advances in endovascular therapies have dramatically improved outcomes compared to historical surgical treatments, and neurosurgeons are an essential component of the multidisciplinary critical care team. OBJECTIVE To retrospectively review pediatric patients with VOGM treated at Texas Children's Hospital (TCH), a quaternary referral center, over 15 yr, and present lessons learned in treating children with modern endovascular techniques. METHODS Charts from TCH were retrospectively reviewed for the past 15 yr. Patients with diagnosis including "Vein of Galen," "Vein of Galen malformation," "Vein of Galen aneurysmal malformation," or any abbreviations (ie, VOG, VOGM, VOGAM) were reviewed. Presentation, imaging, treatment specifics, and clinical outcomes were reported. RESULTS There were 18 patients with VOGM managed at TCH from 2002 to 2018 with a total of 29 embolizations. Seventeen were performed with a single embolisate (NBCA or Onyx), and 12 with a combination. A dual lumen balloon catheter was used as an adjunct in 3 embolizations. Complications occurred in 5 embolizations (24%), including hemorrhage, embolisate migration, and femoral vessel occlusion. Surviving patients were followed for a mean of 38 mo, with 12 having normal or near-normal neurological development. CONCLUSION VOGM can present with a myriad of neurological and systemic symptoms, potentially in extremis. Neurosurgical involvement in these cases is critical, as urgent treatment can be lifesaving. Patients may require multiple treatment sessions using a variety of endovascular tools and techniques.

更新日期：2019-11-01

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