Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis [PEDIATRICS]

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.