GALEN VEN ANEVRİZMASINDA ENDOVASKÜLER YAKLAŞIM: ALTI YILLIK DENEYİMİMİZ VE GÜNCEL LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ

Yıl 2023, , 167 - 172, 05.04.2023

Mehmet Tekin , Musa Silahlı , Zeynel Gökmen , Çağrı Kesim

https://doi.org/10.18229/kocatepetip.1022718

Öz

AMAÇ: Altı yıllık süreçte merkezimizde takip edilip Galen ven anevrizmal malformasyonu (GVAM) tanısı almış vakaların mortalite ve morbidite sonuçlarını inceleyerek güncel literatür bilgisi ile karşılaştırmak.
GEREÇ VE YÖNTEM: 01.01.2014 - 01.01.2020 tarihleri arasında hastanemizde GVAM tanısı ile endovasküler tedavi uygulanan 6 hastanın bilgileri retrospektif olarak değerlendirildi. Hastaların klinik verileri ve demografik bilgileri medikal kayıtlardan elde edildi.
BULGULAR: Bu dönemde takip edilen 6 hastanın hepsine transarteriyel embolizasyon tedavisi uygulandı. Hastaların 4’ü erkek (%67) 2’si ise kadındı (%33). Tanı yaşı açısından değerlendirildiğinde 6 hastanın tamamının tanısı antenatal ya da yeni doğan döneminde konulmuştu. Kısıtlı sayıdaki vaka serimizde mortalite oranı %17 idi. Dört vakada hidrosefali saptandı (%67). Embolizasyon işlemi uygulanan hastalarımızın birinde embolizasyon sırasında kanama, birinde ise işlem sonrası femoral arterde tromboz meydana geldi.
SONUÇ: Çalışmamız, antenatal ve yenidoğan döneminde tanı alan GVAM’lu vakaların değerlendirildiği benzer çalışmalardaki sonuçlarla uyumlu veriler ortaya koymuştur.Çalışmamızda değerlendirememiş olsak da, son çalışmalarda da ön plana çıkan nörokognitif uzun dönem klinik sonuçların iyileştirilmesi gerektiği aşikardır. Halen galen ven anevrizmalı hastalarda standart yaklaşım ve tedavi protokollerine ihtiyaç bulunmaktadır.

Anahtar Kelimeler

Serebral venler, Endovasküler prosedürler, İntrakraniyal arteriyovenöz malformasyonlar

Destekleyen Kurum

Başkent Üniversitesi Araştırma Fonu

Proje Numarası

KA21/404

ENDOVASCULAR APPROACH IN GALEN VEIN ANEURYSM: OUR SIX-YEAR EXPERIENCE AND REVIEW OF THE CURRENT LITERATURE

Öz

OBJECTIVE: To examine the mortality and morbidity results of patients who were followed up in our center for the 6 years period and diagnosed with Galen vein aneurysmal malformation (GVAM) and to compare them with current literature.
MATERIAL AND METHODS: The data of 6 GVAM patients treated with the endovascular procedure in our hospital between 01.01.2014 - 01.01.2020 were retrospectively evaluated. Clinical data and demographic information of the patients were obtained from medical records.
RESULTS: Transarterial embolization was applied to all 6 patients who were followed up during this period. Four of the patients were male (67%) and 2 were female (33%). When evaluated in terms of age at diagnosis, all 6 patients were diagnosed in antenatal or neonatal period. Mortality rate was 17% in our limited number of case series. Hydrocephalus was detected in 4 cases (67%). In one of our patients who underwent embolization, bleeding occurred during embolization and in one patient thrombosis occurred in the femoral artery after the procedure.
CONCLUSIONS: Our study revealed data consistent with the results of similar studies evaluating cases with GVAM diagnosed in the antenatal and neonatal periods. Although we could not assess this in our study, it is obvious that long-term neurocognitive clinical outcomes, which have also come to the fore in recent studies, need to be improved.Currently, there is a need for a standard approach and treatment protocols in patients with venous aneurysm.

Anahtar Kelimeler

Cerebral Veins, Endovascular Procedures, Intracranial Arteriovenous Malformations

Proje Numarası

KA21/404

Kaynakça

• 1. Yan J, Wen J, Gopaul R, Zhang CY, et al. Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis. J Neurosurg. 2015;(123):872–90.
• 2. Lasjaunias P, ter Brugge KG, Berenstein A, editörler. Vein of Galen aneurysmal malformation. İçinde: Surgical neuroangiography: vol. 3: clinical and interventional aspects in children. Paris: Springer Science & Business Media. 2007:11-40.
• 3. Jones BV, Ball WS, Tomsick TA, et al. Vein of Galen aneurysmal malformation: diagnosis and treatment of 13 children with extended clinical follow-up. AJNR Am JNeuroradiol. 2002;(23):1717–24.
• 4. Gailloud P, O’Riordan DP, Burger I, et al. Diagnosis and Management of Vein of Galen Aneurysmal Malformations. Journal of Perinatology. 2005;(25):542–51.
• 5. Mitchell PJ, Rosenfeld JV, Dargaville P, et al. Endovascular management of vein ofGalen aneurysmal malformations presenting in the neonatal period. AJNR Am JNeuroradiol. 2001;(22):1403–9.
• 6. Sivasankar R, Limaye US, Wuppalapati S, et al. Endovascular Management of Vein of Galen Aneurysmal Malformations: A Retrospective Analysis over a 15-Year Period. J Vasc Interv Neurol. 2019;10(3):23-29.
• 7. Lasjaunias PL, Alvarez H, Rodesch G, et al. Aneurysmal malformations of the vein of Galen.Follow-up of 120 children treated between 1984 and 1994. Interv Neuro-Radiol. 1996;(2):15-26.
• 8. Lasjaunias PL, Chng SM, Sachet M, et al. The management of vein of Galen aneurysmal malformations. Neurosurgery. 2006;59(3):184-94.
• 9. Brunelle F. Arteriovenous malformation of the vein of Galen in children. Pediatr Radiol.1997;(27): 501–13.
• 10. Giorgi L, Durand P, Morin L, et al. Management and Outcomes of Neonatal Arteriovenous Brain Malformations with Cardiac Failure: A 17 Years' Experience in a Tertiary Referral Center. J Pediatr. 2019:1-7.
• 11. Bhatia K, Mendes Pereira V, Krings T, et al. Factors Contributing to Major Neurological Complications From Vein of Galen Malformation Embolization. JAMA Neurol. 2020; (8):992-999.
• 12. Malarbi S, Gunn-Charlton JK, Burnett AC, et al. Outcome of vein of Galen malformation presenting in the neonatal period. Arch Dis Child. 2019;104(11):1064-69.
• 13. Taffin H, Maurey H, Ozanne A, et al. Long-term outcome of vein of Galen malformation. Dev Med Child Neurol. 2019:1-6.
• 14. Saliou G, Vraka I, Teglas JP, et al. Pseudofeeders on fetal magnetic resonance imaging predict outcome in vein of Galen malformations. Ann Neurol. 2017;(81):278–86.
• 15. Meila D, Grieb D, Melber K, et al. Hydrocephalus in vein of Galen malformation: etiologies and therapeutic management implications. Acta Neurochir (Wien). 2016;(158):1279–84.
• 16. Turkyilmaz G, Arisoy R, Turkyilmaz S, et al. The outcome of the vein of Galen aneurysmal malformation cases diagnosed prenatally. J Obstet Gynaecol. 2022; (12):1-5.
• 17. Brinjikji W, Krings T, Murad MH, Rouchaud A, Meila D. Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2017;38(12):2308-2314.
• 18. Spazzapan P, Milosevic Z and Velnar T. Vein of Galen aneurismal malformations - clinical characteristics, treatment and presentation: Three cases report. World J Clin Cases. 2019;7(7):855-862.
• 19. Brunelle F. Arteriovenous malformation of the vein of Galen in children. Pediatr Radiol.1997;(27):501-513.