Vein of Galen Malformation (VOGM)

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If your child has been diagnosed with a vein of Galen malformation (VOGM) before or after birth, Duke’s team of specialists provides high-quality care. Our neurosurgeons are among the few experts on the East Coast equipped to repair these rare misconnections between arteries and veins using a minimally invasive procedure. We can coordinate your child’s care before they are even born to reduce the risk of life-threatening complications. 

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About Vein of Galen Malformation

Vein of Galen malformations are a type of arteriovenous malformation. They form in the developing fetus when an artery in the brain connects directly with a vein instead of capillaries, which are missing. Without these capillaries, blood flows too quickly back to the heart, and oxygen is not distributed well in the brain or other organs. This malformation, which doctors sometimes call a fistula, can cause complications, including: 

  • Brain injury and neurodevelopmental delay
  • Heart failure or other organ failure
  • Hydrocephalus
  • Pulmonary hypertension (high blood pressure in the lungs)
Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Diagnosis and Testing

Vein of Galen malformations are often detected during a routine prenatal ultrasound. In these cases, we work closely with your obstetrician and perinatologists to coordinate delivery at Duke Birthing Center so that our team is ready to act as soon as your baby is born.

Sometimes, a vein of Galen malformation is detected during a standard newborn heart screening or even months after birth. 

After your child is born, their doctor may recommend an MRI or another imaging scan to capture detailed images of their brain. Doctors may also use one or more scoring tools to categorize how severe your child’s malformation is. 

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Endovascular Embolization

Endovascular embolization is the most effective treatment for vein of Galen malformations. During this minimally invasive procedure, an endovascular neurosurgeon inserts a tiny tube called a catheter into a blood vessel near the groin and navigates the catheter to the fistula. Glue or metal coils are strategically placed to shrink the neck of the fistula(s), which significantly reduces blood flow to the malformation.

Most children require more than one endovascular embolization treatment, sometimes days or months apart. That’s because the body needs time to adjust to the change in blood flow. It’s common for children to experience a noticeable improvement in heart function or other symptoms during or immediately after each procedure.


A watchful waiting approach may be best for children whose malformations are small and not causing serious complications. Medicines can help support the heart or other organs until the malformation can be embolized.

Children with severe cases -- especially those who need ventilator support -- are more likely to need immediate endovascular embolization. Your child’s care team will carefully weigh when to perform the procedure since the risks of complications like stroke or blood vessel injury are lower in older infants with larger blood vessels.

Follow-Up Care

After embolization, your child’s doctor will recommend routine follow-up appointments and MRI scans to monitor the malformation, as well as your child’s overall growth and development. 

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Why Choose Duke

Team Approach to Care
Because vein of Galen malformations can affect so many different body systems, your child’s care team will include neonatologists, pediatricians, pediatric cardiologists, pediatric neurologists and neurosurgeons, endovascular neurosurgeons, neuroanesthesiologists, radiologists, intensivists (doctors who specialize in providing care to critically ill people), and others. We combine our expertise to ensure your child achieves the best possible outcome.

Highly Skilled Endovascular Neurosurgeons
Endovascular embolization is an extremely complex procedure, partly because of how small infant blood vessels are. It’s important to seek care at a center like Duke, where our endovascular neurosurgeons have the skill and experience to successfully treat vein of Galen malformations with low complication rates.

Advanced Facilities, Trained Providers
Our catheterization labs, pediatric intensive care units, birthing center, and other facilities are equipped with the latest technology and staffed with personnel who routinely care for babies with complex medical conditions like vein of Galen malformations.

This page was medically reviewed on 01/04/2023 by