Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta Analysis
BACKGROUND: Outcomes after endovascular embolization of vein of Galen malformations remain relatively poorly described. PURPOSE: We performed a systematic review of the literature to determine outcomes and predictors of good outcomes following endovascular treatment of vein of Galen malformations. DATA SOURCES: We used Ovid MEDLINE, Ovid Embase, and the Web of Science. STUDY SELECTION: Our study consisted of all case series with =4 patients receiving endovascular treatment of vein of Galen malformations published through January 2017. DATA ANALYSIS: We studied the following outcomes: complete/near complete occlusion rates, technical complications, perioperative stroke, perioperative hemorrhage, technical mortality, all cause mortality, poor neurologic outcomes, and good neurologic outcomes. Outcomes were stratified by age group (neonate, infant, child) A random effects meta analysis was performed. DATA SYNTHESIS: A total of 27 series with 578 patients were included; 41.9% of patients were neonates, 45.0% of patients were infants, and 13.1% of patients were children. All cause mortality was 14.0% (95% CI, 8.0% 22.0% Overall good neurologic outcome rates were 62.0% (95% CI, 57.0% 67.0% Overall poor neurologic outcome rates were 21.0% (95% CI, 17.0% 26.0% Neonates were significantly less likely to have good neurologic outcomes than infants (48.0% 95% CI, 35.0% 62.0% versus 77.0% 95% CI, 70.0% 84.0% P .01) Treatment indications following the Bicetre neonatal evaluation score resulted in significantly higher rates of good neurologic outcome (P .04) Patients with congestive heart failure had significantly lower rates of good neurologic outcome (OR, 0.50; 95% CI, 0.28 0.88; P .01) LIMITATIONS: Limitations were selection and publication biases. CONCLUSIONS: Patients receiving endovascular embolization of vein of Galen malformations experienced good long term clinical outcomes in >60% of cases. Appropriate patient selection is key as treatment guided by the Bicetre neonatal evaluation score was associated with improved neurologic outcomes.
American Journal of Neuroradiology