Ultrasound-guided transuterine coil embolization of a Vein of Galen malformation

Vein of Galen malformations (VOGMs) are rare and complex congenital vascular anomalies that can lead to severe morbidity and mortality. Management predominantly focuses on postnatal endovascular interventions. However, these may not be feasible for fetuses with hemodynamic instability and high-output cardiac failure and may fail to prevent irreversible brain damage induced by prolonged compression by the venous varix, hemodynamic alterations and resultant potential ischemic injury. In utero endovascular embolization in high-risk VOGM fetuses may decrease mortality, prevent cardiac decompensation, and improve neurological and cognitive outcomes, thereby potentially establishing a novel standard of care for these challenging cases. We present a case of a fetus with VOGM, managed via a multidisciplinary approach through ultrasound-guided, in utero endovascular embolization. The procedure was successfully performed without complications, and the mother was discharged in good condition. At birth and a 3-month follow-up, the newborn demonstrated normal heart and respiratory function. The newborn is scheduled for diagnostic angiography and potential embolization at 6 months post-delivery •This is the fourth reported case demonstrating the feasibility of in-utero embolization for VOGM.•The procedure demonstrated a significant reduction in vascular shunting and improved fetal cardiac function, preventing irreversible neurological damage that can be encountered in conventional post-natal treatment.•The study provides a foundation for advancing in-utero interventions as a potential standard of care for select high-risk VOGM cases.