• Alex Berenstein, Johanna T Fifi, Yasunari Niimi, Salvatore Presti, Rafael Ortiz, Saadi Ghatan, Barak Rosenn, Michelle Sorscher, and Walter Molofsky.
• Center for Endovascular Surgery, Hyman Newman Institute for Neurology and Neurosurgery, St. Luke's Roosevelt Hospital Center, New York, New York 10019, USA.
• Neurosurgery. 2012 May 1;70(5):1207-13; discussion 1213-4.

BackgroundUntreated patients with symptomatic neonatal presentation of vein of Galen aneurismal malformations (VGAMs) carry almost 100% morbidity and mortality. Medical management and endovascular techniques for neonatal treatment have significantly evolved.ObjectiveTo evaluate the clinical and angiographic outcomes of modern management of neonates with refractory heart failure from VGAMs.MethodsFrom 2005 to 2010, 16 neonatal patients with VGAM presented to our institution. Medical care from the prenatal to perinatal stages was undertaken according to specified institutional guidelines. Nine patients with refractory heart failure required neonatal endovascular intervention. All patients were treated by transarterial deposition of n-butyl cyanoacrylate into fistula sites. Short- and long-term angiographic studies and clinical outcomes were reviewed.ResultsControl of heart failure was achieved in 8 patients. One premature baby died shortly after treatment. Long-term angiographic follow-up shows total or near-total angiographic obliteration in all 8 patients. One patient has a mild hemiparesis from treatment. Another has a mild developmental delay. One patient developed a severe seizure disorder and developmental delay. Overall, 66.7% patients have normal neurological development with near-total or total obliteration of the malformation.ConclusionTreatment of refractory heart failure in neonatal VGAM with modern prenatal, neurointensive, neuroanesthetic, and pediatric neuroendovascular care results in significantly improved outcomes with presumed cure and normal neurological development in most.

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