Vein of Galen Aneurysmal Malformations: Retrospective Evaluation of Endovascular Treatment Outcomes

Abstract Purpose: Vein of Galen Aneurysmal Malformations (VGAM) are rare congenital vascular anomalies that present significant management challenges due to their complex vascular anatomy and hemodynamic impact. This study retrospectively evaluates the clinical outcomes of VGAM patients treated with endovascular embolization, assessing procedural success, mortality, morbidity, and prognostic factors influencing long-term outcomes. Methods: A retrospective analysis was conducted on 26 patients diagnosed with VGAM and treated with endovascular embolization between 2005 and 2024. Patients were classified based on diagnosis timing, age at treatment (neonatal, infancy, childhood, or adulthood), and VGAM subtype (mixed, choroidal, or mural). Clinical, echocardiographic, and imaging data were collected. Primary outcomes included survival, neurological status, and the need for repeat embolization or surgical interventions. Results: Among 26 patients, 6 (23.1%) were female and 20 (76.9%) were male. Prenatal diagnosis was made in 15 cases (57.7%), while 11 (42.3%) were diagnosed postnatally. Endovascular embolization was performed in 24 patients (92.3%), with 11 (42.3%) requiring repeat procedures. Mortality was recorded in 6 patients (23%), all of whom had severe heart failure, and 4 had undergone embolization. Hydrocephalus was present in 14 patients (53.8%), with 6 requiring neurosurgical intervention. Among survivors, 19.2% exhibited developmental delay, while others maintained stable neurological function. Conclusion: Endovascular embolization is an effective treatment for VGAM, though complications such as heart failure and hydrocephalus significantly impact outcomes. Early intervention improves survival, but neonates with high-output cardiac failure remain at high risk. Further research is needed to refine VGAM classification systems and establish standardized treatment protocols.