{
  "abstract": "Introduction The Vein of Galen Malformation (VGM) is a rare intracranial vascular malformation in which arteriovenous connections between primary choroidal vessels and the median prosencephalic vein arise between the 6 th and 12th week of foetal development. The foetus shows no cardiovascular symptoms as the low resistance of the AVM is balanced by the low vascular resistance in the placenta. After birth up to 70% of cardiac output is directed through the low-resistance VGM leading to volume load of the right heart and consecutive heart failure (Frawley et al., 2002). Untreated the cause is fatal. Therapy of choice is endovascular embolization.Case Description A vein of Galen malformation was diagnosed prenatally (SSW 41) in an intrauterine MRI with no prior abnormalities detected during pregnancy. Following diagnosis, the caesarean section was scheduled for the next day with immediate postnatal embolization strategically planned in advance. Initial postnatal echocardiography showed right heart dilation (RV-RA gradient: 40 mmHg). Cerebral DSA confirmed the VGM with multiple macro- and microshunts, mainly from the left pericallosal artery and right posterior choroidal artery ( fig. 1). Embolization of the largest macroshunt from the pericallosal artery was performed, reducing shunt volume resulting in reduced fistula flow and hemodynamic improvement (RV-RA gradient post-intervention: 36 mmHg). Clinical and hemodynamic controls followed with plans for staged consecutive embolization in infancy.Conclusions Ultraearly embolization therapy of VGMs as well as pre-procedural planning are essential to minimise radiation exposure, reduce high-output heart failure and thus improving the prognosis of affected newborns.Abstarct C63 Figure 1a-b: Intrauterine MRI shows a large vein of Galen malformation (VGM) with prominent macroshunts predominantly originating from the left side. c-h: Access via the umbilical artery, standard projections and embolization of the choroidal-type vein of Galen malformation (VGM). Due to the prominent feeders from the left side, the right ACI was not visualised in order to reduce contrast agent and radiation. c-e: Standard projection series via the left vertebral artery with a 4F vertebral catheter. VGM with multiple feeders from the left pericallosal artery (c), also from the Percheron artery and thalamoperforators (d) and of the right posterior choroidal artery (e) with venous drainage via a massively dilated median prosencephalic vein and the massively dilated falcine sinus. f-g: Catheterisation of the left ACI using a 4F Fargo, a Scepter Mini microcatheter balloon with a ChikaiX0.08 microwire. Successful complete embolization of the macroshunt with EVOH (Onyx18) under fluoroscopy. h: Post-embolization shows a significant reduction of the fistula volume with continuing residual findings. Arrow: macroshunt from the left pericallosal artery pre- and post-embolization. AT: accessory torcula, FS: falcine sinus, PA: pericallosal artery, VA: vertebral artery (left), VGM: Vein of Galen Malformation.Conflict of Interest No",
  "authors": [
    {
      "affiliations": [
        "University Hospital Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany"
      ],
      "name": "Laura Valentina Klüner"
    },
    {
      "affiliations": [
        "University Hospital Essen, Clinic for Neurosurgery and Spinal Surgery, Essen, Germany"
      ],
      "name": "Philipp Dammann"
    },
    {
      "affiliations": [
        "University Hospital Essen, Clinic for Paediatrics, Essen, Germany"
      ],
      "name": "Carsten Muentjes"
    },
    {
      "affiliations": [
        "University Hospital Essen, Neonatology, Essen, Germany"
      ],
      "name": "Johanna Bialas"
    },
    {
      "affiliations": [
        "University Hospital Essen, Clinic for Anaesthesiology and Intensive Care Medicine, Essen, Germany"
      ],
      "name": "Tamara Dietrich"
    },
    {
      "affiliations": [
        "University Hospital Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany"
      ],
      "name": "Michael Forsting"
    },
    {
      "affiliations": [
        "Alfried Krupp Hospital, Clinic for Radiology and Neuroradiology, Essen, Germany"
      ],
      "name": "René Chapot"
    },
    {
      "affiliations": [
        "University Hospital Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, Essen, Germany"
      ],
      "name": "Cornelius Deuschl"
    }
  ],
  "title": "C100 Vein of galen malformation: the importance of early diagnosis and treatment in preventing high-output cardiac failure",
  "uid": "bc48d3ee-206f-50a4-9d11-41efa9b623d3"
}