Arterial approach in vein of Galen aneurysmal malformation: Coils and EVOH

The vein of Galen aneurysmatic malformation VAGM, is a rare intracranial vascular malformation, that represents approximately 1 % of neurovascular malformations and 20–30 % of all pediatric vascular malformations, although it has high rates of morbidity, it can be treated with an endovascular approach, with better results. We made a retrospective, monocentric study with a total of 4 patients with a diagnostic vein of Galen malformation over a period of 9 years, reviewing medical charts, and diagnostic imaging studies, using the Bicêtre score to decide treatment, and using new techniques, combining materials in one or multiple sessions. Complete occlusion was achieved in all cases, almost all cases (75 %) had a better clinical presentation from the first session with just one embolization session, in 50 % of patients (2/4) both with a mural feeders type 2 and 1, respectively. The case with the lowest score 8/21, died after the first embolization session due to multiorgan dysfunction syndrome. An endovascular arterial approach combining EVOH, and coils is considered the best technique to treat vein of Galen aneurysmal malformation, because it has better control of the embolization, adding security and precision in the right hands, while also enhancing the cost-effectiveness of the procedure.