PT  - JOURNAL ARTICLE
AU  - C F Dowd
AU  - V V Halbach
AU  - S L Barnwell
AU  - R T Higashida
AU  - M S Edwards
AU  - G B Hieshima
TI  - Transfemoral venous embolization of vein of Galen malformations.
DP  - 1990 Jul 01
TA  - American Journal of Neuroradiology
PG  - 643--648
VI  - 11
IP  - 4
4099  - http://www.ajnr.org/content/11/4/643.short
4100  - http://www.ajnr.org/content/11/4/643.full
SO  - Am. J. Neuroradiol.1990 Jul 01; 11
AB  - Three infants with vein of Galen malformations, all presenting with congestive heart failure, underwent a total of five embolization procedures that employed a percutaneous transfemoral venous approach to catheterize the vein of Galen. In one instance, direct retrograde catheterization of feeding arterial pedicles to the vein of Galen and embolization of the fistulous connections was achieved via this route. The indications for transfemoral venous treatment included persistent symptoms despite transarterial and transtorcular embolization in one patient, an unsuccessful transarterial embolization attempt (complicated by catheter fracture) in another, and the inadvisability of transarterial embolization because of an excessive number of feeding arteries in a third. Complete obliteration of the malformation was achieved in one patient and significant flow reduction in the other two. Vein of Galen perforation with the catheter tip complicated one procedure. All three patients were stable after clinical follow-ups (9-12 months). The transvenous route to the vein of Galen can be undertaken from a transfemoral approach, obviating surgical exposure of the torcular Herophili. In addition, we introduce the concept of direct retrograde catheterization of the feeding arteries to the vein of Galen malformation by a transfemoral venous approach, a procedure that has not been reported previously.