Endovascular treatment of vein of Galen malformations: A systematic review and meta-Analysis

Waleed Brinjikji, T. Krings, Mohammad H Murad, A. Rouchaud, D. Meila

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

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 Bicêtre 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 Bicêtre neonatal evaluation score was associated with improved neurologic outcomes.

Original languageEnglish (US)
Pages (from-to)2308-2314
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume38
Issue number12
DOIs
StatePublished - Dec 1 2017

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Vein of Galen Malformations
Nervous System
Meta-Analysis
Newborn Infant
Therapeutics
Mortality
Publication Bias
Selection Bias
MEDLINE
Patient Selection
Heart Failure
Age Groups
Stroke
Hemorrhage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Endovascular treatment of vein of Galen malformations : A systematic review and meta-Analysis. / Brinjikji, Waleed; Krings, T.; Murad, Mohammad H; Rouchaud, A.; Meila, D.

In: American Journal of Neuroradiology, Vol. 38, No. 12, 01.12.2017, p. 2308-2314.

Research output: Contribution to journalReview article

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abstract = "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 Bic{\^e}tre 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 Bic{\^e}tre neonatal evaluation score was associated with improved neurologic outcomes.",
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T1 - Endovascular treatment of vein of Galen malformations

T2 - A systematic review and meta-Analysis

AU - Brinjikji, Waleed

AU - Krings, T.

AU - Murad, Mohammad H

AU - Rouchaud, A.

AU - Meila, D.

PY - 2017/12/1

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N2 - 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 Bicêtre 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 Bicêtre neonatal evaluation score was associated with improved neurologic outcomes.

AB - 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 Bicêtre 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 Bicêtre neonatal evaluation score was associated with improved neurologic outcomes.

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