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
- Pulmonary hypertension (high blood pressure in the lungs)
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.
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.