RT Journal Article SR Electronic T1 Endovascular Treatment of Vein of Galen Malformations: A Systematic Review and Meta-Analysis JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology DO 10.3174/ajnr.A5403 A1 W. Brinjikji A1 T. Krings A1 M.H. Murad A1 A. Rouchaud A1 D. Meila YR 2017 UL http://www.ajnr.org/content/early/2017/10/05/ajnr.A5403.abstract AB BACKGROUND: Outcomes after endovascular embolization of vein of Galen malformations remain relatively poorly described.PURPOSE: We performed a systematic review of the literature to determine outcomes and predictors of good outcomes following endovascular treatment of vein of Galen malformations.DATA SOURCES: We used Ovid MEDLINE, Ovid Embase, and the Web of Science.STUDY SELECTION: Our study consisted of all case series with ≥4 patients receiving endovascular treatment of vein of Galen malformations published through January 2017.DATA ANALYSIS: We studied the following outcomes: complete/near-complete occlusion rates, technical complications, perioperative stroke, perioperative hemorrhage, technical mortality, all-cause mortality, poor neurologic outcomes, and good neurologic outcomes. Outcomes were stratified by age-group (neonate, infant, child). A random-effects meta-analysis was performed.DATA SYNTHESIS: A total of 27 series with 578 patients were included; 41.9% of patients were neonates, 45.0% of patients were infants, and 13.1% of patients were children. All-cause mortality was 14.0% (95% CI, 8.0%–22.0%). Overall good neurologic outcome rates were 62.0% (95% CI, 57.0%–67.0%). Overall poor neurologic outcome rates were 21.0% (95% CI, 17.0%–26.0%). Neonates were significantly less likely to have good neurologic outcomes than infants (48.0%; 95% CI, 35.0%–62.0% versus 77.0%; 95% CI, 70.0%–84.0%; P < .01). Treatment indications following the Bicêtre neonatal evaluation score resulted in significantly higher rates of good neurologic outcome (P = .04). Patients with congestive heart failure had significantly lower rates of good neurologic outcome (OR, 0.50; 95% CI, 0.28–0.88; P = .01).LIMITATIONS: Limitations were selection and publication biases.CONCLUSIONS: Patients receiving endovascular embolization of vein of Galen malformations experienced good long-term clinical outcomes in >60% of cases. Appropriate patient selection is key as treatment guided by the Bicêtre neonatal evaluation score was associated with improved neurologic outcomes.BNESBicêtre neonatal evaluation scoreCHFcongestive heart failurePRISMAPreferred Reporting Items for Systematic Reviews and Meta-AnalysesVOGMvein of Galen arteriovenous malformation