Management of Vein of Galen Aneurysmal Malformation in a Neonate: A Tightrope Walk

The vein of Galen aneurysmal malformation (VGAM) is a rare congenital intracranial high-flow arterio-venous shunt that can cause high-output cardiac failure in the neonate. Embolization of the VGAM by interventional neuroradiology is the procedure of choice. Treatment decisions should be individualized and based on a scoring system like the Bicetre score. We report our experience of the anesthetic management of a neonate with high-output cardiac failure who underwent transarterial embolization. We highlight the risk of acute pulmonary edema during the procedure and stress the importance of strict fluid and hemodynamic management.