Vein of Galen Malformation Treatment in Children

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The goal of treating a vein of Galen malformation (VOGM) is to eliminate or decrease as much of the blood flow through the VOGM as possible, while maximizing the blood supply to the brain. In almost all cases we see at Boston Children's Hospital, we use endovascular embolization, a minimally invasive, catheter-based procedure. Recovery is usually rapid, and most children can go on to live full and active lives. We have pioneered the practice of performing an additional angiogram before waking the child from anesthesia to verify that the treatment was successful.

Vein of Galen Malformations VOGM Treatment

vein of galen malformations vogm post treatment

Endovascular Embolization Process for VOGM

  • To begin the embolization procedure, an interventional neuroradiologist inserts a catheter (a thin, flexible tube) into an artery in the child’s groin through a tiny incision. Under x-ray guidance and with the help of soft wires, the catheter is advanced up the aorta (the main artery in the middle of the body) through the arteries leading to the VOGM. Multiple angiographic images may be taken to determine which vessels need embolization.
  • The neurointerventionalist then threads a smaller microcatheter through the first catheter to inject specialized materials into the vessels of the VOGM. These materials close off blood flow through the malformation from the inside and can vary from a fast-acting, glue-like compound to soft metal coils. We continually adapt new materials and devices designed for adults for use in children.
  • When the procedure is done, we remove the catheters, place a bandage over the site on the groin and transfer the child to the recovery room or to the ICU for observation.
  • To maximize safety, embolization is often performed in more than one procedure. Complications are rare, and our imaging protocols have been adjusted to minimize children’s exposure to ionizing radiation (x-rays).
  • No patient with heart failure is too young or too small to be treated: To date, our youngest patient to undergo embolization was a 35-week premature infant weighing 2 kg (4.4 lbs).
  • Most children have no pain or other symptoms with embolization, and most are able to leave the hospital within a few days. Some children will need to spend several days in the ICU for observation. Parents are welcome to stay with their children in the recovery room, the ICU and the hospital floor rooms afterward.
  • After discharge, we ask children to return for a follow-up office visit within a few weeks. Follow up may be in part through video teleconference for patients who live outside the Boston area.

Preparing for an endovascular embolization

If your child is scheduled for endovascular embolization, you will receive specific information on how to prepare. Because general anesthesia is used in endovascular embolization, your child may need to stop eating, drinking and sometimes taking medicines for a certain period of time.

 

Upon arrival, plan to spend about four hours meeting with nurses, the anesthesiologist and the neurointerventionalist. Children can bring a favorite toy or blanket into the procedure room, and parents can stay close by, in the family waiting area.



We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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