Vein of Galen aneurysmal malformation treatment with direct open surgical access of the transverse sinus and transvenous selective endovascular embolization: a hybrid approach.

Gravino, Gilbert; Aamir, Saad; Dietvorst, Sofie; Bhatt, Kush; Robertson, Fergus; Parks, Chris; Craig, Richard; Mallucci, Conor; Chandran, Arun; Puthuran, Mani

Abstract

Vein of Galen aneurysmal malformations (VOGMs) are rare congenital cerebrovascular malformations associated with an almost 100% morbidity and mortality rate if untreated. Open surgical case reports had reported intraoperative neonatal mortality rates close to 100%, rendering the disease untreatable. The development of endovascular techniques subsequently provided a viable treatment option for these complex cases, with a staged transarterial approach currently being the preferred mainstay treatment.We report on a technique that involves direct exposure of the transverse sinus under image-guided mini-craniotomy in a vascular hybrid intraoperative theater, followed by direct puncture of the transverse sinus with venous access to embolize the VOGM via a transvenous route. This was performed in a 3-year-old patient in whom further transarterial embolization was not feasible and who had bilateral occlusion of the internal jugular veins. The procedure was successful, with elimination of the high-flow arteriovenous shunt and no procedure-related complications. [Abstract copyright: © Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.]

Citation

Gravino, G., Aamir, S., Dietvorst, S., Bhatt, K., Robertson, F., Parks, C., Craig, R., Mallucci, C., Chandran, A., & Puthuran, M. (2025). Vein of Galen aneurysmal malformation treatment with direct open surgical access of the transverse sinus and transvenous selective endovascular embolization: a hybrid approach. Journal of NeuroInterventional Surgery, https://doi.org/10.1136/jnis-2025-023490

• Journal Article Type: Article
• Acceptance Date: May 18, 2025
• Online Publication Date: Jun 19, 2025
• Publication Date: Jun 19, 2025
• Deposit Date: Jul 7, 2025
• Journal: Journal of neurointerventional surgery
• Print ISSN: 1759-8478
• Electronic ISSN: 1759-8486
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1136/jnis-2025-023490
• Keywords: Technique, Intervention, Vascular Malformation, Congenital, Brain
• Public URL: https://keele-repository.worktribe.com/output/1318827
• Publisher URL: https://jnis.bmj.com/content/early/2025/06/18/jnis-2025-023490