Dan Meila1,2, Dominik Grieb3, Katharina Melber3, Collin Jacobs4, Homajoun Maslehaty5, Athanasios Petridis6, Rashad El Habony7, Heinrich Lanfermann8, Martin Scholz7, Friedhelm Brassel3. 1. Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen 9, 47055, Duisburg, Germany. dmeila@yahoo.de. 2. Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. dmeila@yahoo.de. 3. Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen 9, 47055, Duisburg, Germany. 4. Department of Orthodontics, University of Mainz, Mainz, Germany. 5. Department of Neurosurgery, University Hospital Essen, Essen, Germany. 6. Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany. 7. Department of Neurosurgery, Sana Kliniken Duisburg, Duisburg, Germany. 8. Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Abstract
BACKGROUND: Up to now, only little is known about hydrocephalus (HC) in vein of Galen malformation (VGM). We want to present the different etiologies and our long-term experience (1992-2015) in the management of HC. METHODS: Out of 44 treated children with VGM, we retrospectively reviewed all cases with HC. We analyzed the etiologies, our treatment results and complications. RESULTS: Twenty-one children (48 %) presented either with HC or developed it over time. In 21 % of those cases, high venous pressure was presumably the sole cause. Until 2009, seven of them received ventriculoperitoneal (VP) shunting; six of those resulted in severe postoperative complications. The remaining children have been treated successfully by endovascular embolization. Five out of the 44 children (11 %) developed HC after intraventricular hemorrhage. In four cases, those children were treated with positive results by using transient external ventricular drainages. In one case a VP shunt with highest valve pressure was inserted. Another four children (9 %) presented with aqueductal stenosis-related HC caused by either dilated venous outflow or space-occupying coil masses after embolization. The latter case was successfully treated by ventriculocisternostomy, whereas endovascular treatment decreased the venous outflow in size and thus resolved the HC in the other cases. In the remaining cases (7 %), atrophy due to melting brain syndrome led to HC ex vacuo. CONCLUSIONS: HC in VGM is a common phenomenon with several etiologies requiring different treatments. In most cases, embolization of the VGM as sole treatment is completely sufficient in order to decrease high venous pressure. However, certain other causes of HC should be treated in an interdisciplinary setting by specialized neurosurgeons.
BACKGROUND: Up to now, only little is known about hydrocephalus (HC) in vein of Galen malformation (VGM). We want to present the different etiologies and our long-term experience (1992-2015) in the management of HC. METHODS: Out of 44 treated children with VGM, we retrospectively reviewed all cases with HC. We analyzed the etiologies, our treatment results and complications. RESULTS: Twenty-one children (48 %) presented either with HC or developed it over time. In 21 % of those cases, high venous pressure was presumably the sole cause. Until 2009, seven of them received ventriculoperitoneal (VP) shunting; six of those resulted in severe postoperative complications. The remaining children have been treated successfully by endovascular embolization. Five out of the 44 children (11 %) developed HC after intraventricular hemorrhage. In four cases, those children were treated with positive results by using transient external ventricular drainages. In one case a VP shunt with highest valve pressure was inserted. Another four children (9 %) presented with aqueductal stenosis-related HC caused by either dilated venous outflow or space-occupying coil masses after embolization. The latter case was successfully treated by ventriculocisternostomy, whereas endovascular treatment decreased the venous outflow in size and thus resolved the HC in the other cases. In the remaining cases (7 %), atrophy due to melting brain syndrome led to HC ex vacuo. CONCLUSIONS: HC in VGM is a common phenomenon with several etiologies requiring different treatments. In most cases, embolization of the VGM as sole treatment is completely sufficient in order to decrease high venous pressure. However, certain other causes of HC should be treated in an interdisciplinary setting by specialized neurosurgeons.
Entities:
Keywords:
Embolization; Hydrocephalus; Vein of Galen malformation; Ventriculocisternostomy; Ventriculoperitoneal shunt
Authors: Grant Alexander Bateman; Swee Leong Yap; Gopinath Musuwadi Subramanian; Alexander Robert Bateman Journal: Fluids Barriers CNS Date: 2020-04-29
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