Complications of Therapies for Vein of Galen Malformations in Children

Surgical

The overall complication rate of endovascular embolization for VOGM has been estimated to be between 19% and 37% (25,73,83).

• Common complications: Complications include nontarget embolization, arterial perforations, cerebral hemorrhage, cerebral ischemia, hydrocephalus, failed embolization resulting in persistent heart failure, and leg ischemia.
• Complications of aggressive embolization: Disseminated intravascular coagulation may occur following excessive hemodynamic changes from aggressive embolization.
• Complications of endovascular access, especially in neonates: A significantly higher rate of technical complications — for example, perioperative hemorrhage and ischemia — has been observed in neonates treated using access catheterization or intracranial catheterization compared to infants receiving the same treatment (25).
• Access site complications: Access site complications may be more common in neonates and infants. Anticoagulation therapy may be required to preserve perfusion to the distal lower extremity.
• Predictors of periprocedural complications: Factors associated with periprocedural complications include the presence of normal deep venous drainage to the venous sac (which may lead to venous infarction), excessive embolization of the venous drainage, embolization of proximal before distal feeders, and the use of large microcatheters in neonates (83).

Medical

• Medical complications: Undertreatment of the complications of the high-flow vascular shunt can lead to systemic issues involving organ dysfunction, impaired brain development, and cognitive delay.

Other Therapies

• Complications related to CSF diversion for hydrocephalus: VP shunting for CSF diversion in VOGM patients presenting with hydrocephalus has been associated with complications such as seizures, status epilepticus, hygroma formation, intraventricular hemorrhage, subdural fluid accumulation, subdural hematoma, and new neurological deficits (43,80).