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Clinical Pediatrics, Vol. 30, No. 11, 621-629 (1991)
DOI: 10.1177/000992289103001102

Neonatal Vein of Galen Malformations: Experience in Developing a Multidisciplinary Approach Using an Embolization Treatment Protocol

Deborah M. Friedman, MD

Pediatric Cardiology, New York University Medical Center, 550 First Avenue, New York, NY 10016

Mary Madrid, MA

New York University Medical Center, New York, NY

Alejandro Berenstein, RN

New York University Medical Center, New York, NY

In Sup Choi, MD

New York University Medical Center, New York, NY

Jeffrey H. Wisoff, MD

New York University Medical Center, New York, NY

A multidisciplinary team approach using a staged transcatheter embolization and neurosurgical protocol was applied to 22 patients with neonatal presentation of vein of Galen malformations over a 12 year period. Aggressive medical therapy was combined with interventions including: ventricular shunting, transcatheter embolization, retrograde transtorcular embolization, and neurosurgical obliteration. There was a high frequency of high output cardiac failure, multiple organ system dysfunction, seizures, hydrocephalus, visual, developmental and neurological disability. Of the first 11 patients, five survived; four with seizures and three with marked retardation. Of the last 11 patients, six survived; five with seizures but only one with retardation. Despite persistently high morbidity and mortality, our continuously evolving protocol offers these otherwise hopeless patients some chance of survival.


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