Medical
- Medical management: This involves addressing the cardiac, pulmonary, and other organ system sequelae of VOGM. The use of cardiac inotropes, diuresis, nasal oxygen, noninvasive positive pressure ventilation, intubation, and/or vasodilators may be required, in addition to other management strategies discussed in Stabilization.
Other
CSF diversion surgery (VP shunting or endoscopic third ventriculostomy) is generally reserved for patients with hydrocephalus refractory to embolization (which can reduce local mass effect with reduction of the varix and potentially reduce venous hypertension with reduction of the vascular shunting blocking CSF resorption). VP shunting is frequently (but not always) utilized.
- Ventricular shunting: Reserve VP shunting for patients with hydrocephalus who have already undergone maximal embolization, or for those who are poor candidates for embolization (80). There is an increased rate of complications, likely secondary to venous hypertension, seen with VP shunting in the context of VOGM (43,80).
- ETV: Alternatively, an ETV can be considered to manage VOGM-associated hydrocephalus. It has been successfully used to treat VOGM patients with hydrocephalus (81,82).
- Exceptions: Patients may present with ex vacuo ventriculomegaly due to diffuse brain atrophy; these patients do not require CSF diversion (43).
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