PT  - JOURNAL ARTICLE
AU  - S. Schwarz
AU  - F. Brevis Nuñez
AU  - N.R. Dürr
AU  - F. Brassel
AU  - M. Schlunz-Hendann
AU  - A. Feldkamp
AU  - T. Rosenbaum
AU  - U. Felderhoff-Müser
AU  - K. Schulz
AU  - C. Dohna-Schwake
AU  - N. Bruns
TI  - Doppler Ultrasound Flow Reversal in the Superior Sagittal Sinus to Detect Cerebral Venous Congestion in Vein of Galen Malformation
AID  - 10.3174/ajnr.A7891
DP  - 2023 May 25
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2023/05/25/ajnr.A7891.short
4100  - http://www.ajnr.org/content/early/2023/05/25/ajnr.A7891.full
AB  - BACKGROUND AND PURPOSE: Vein of Galen malformation is a rare congenital cerebrovascular malformation. In affected patients, increased cerebral venous pressure constitutes an important etiologic factor for the development of brain parenchymal damage. The aim of this study was to investigate the potential of serial cerebral venous Doppler measurements to detect and monitor increased cerebral venous pressure.MATERIALS AND METHODS: This was a retrospective monocentric analysis of ultrasound examinations within the first 9 months of life in patients with vein of Galen malformation admitted at <28 days of life. Categorization of perfusion waveforms in the superficial cerebral sinus and veins into 6 patterns was based on antero- and retrograde flow components. We performed an analysis of flow profiles across time and correlation with disease severity, clinical interventions, and congestion damage on cerebral MR imaging.RESULTS: The study included 44 Doppler ultrasound examinations of the superior sagittal sinus and 36 examinations of the cortical veins from 7 patients. Doppler flow profiles before interventional therapy correlated with disease severity determined by the Bicêtre Neonatal Evaluation Score (Spearman ρ = −0.97, P = < .001). At this time, 4 of 7 patients (57.1%) showed a retrograde flow component in the superior sagittal sinus, whereas after embolization, none of the 6 treated patients presented with a retrograde flow component. Only patients with a high retrograde flow component (equal or more than one-third retrograde flow, n = 2) showed severe venous congestion damage on cerebral MR imaging.CONCLUSIONS: Flow profiles in the superficial cerebral sinus and veins appear to be a useful tool to noninvasively detect and monitor cerebral venous congestion in vein of Galen malformation.AVarteriovenousBNESBicêtre Neonatal Evaluation ScorecMRIcerebral MR imagingFPflow profileMPVmedian prosencephalic vein of MarkowskiSSSsuperior sagittal sinusUSultrasoundVGAMVein of Galen (aneurysmal) malformation