Journal article
Galenic Pial Arteriovenous Fistulas in Adults
Journal of the neurological sciences, v 416, 117014
15 Sep 2020
PMID: 32652360
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Vein of Galen aneurysmal malformations (VOGMs) are pial arteriovenous fistulas possessing Galenic venous drainage most commonly presenting during the neonatal period and infancy, with initial discovery during adulthood quite rare.
We conducted a literature survey of the PubMed database in order to identify Galenic pial arteriovenous fistulas (GPAVFs) with major manifestation or initial presentation during adulthood. Inclusionary criteria included pial AVFs with Galenic drainage with major manifestation or initial presentation at, or older than, 18 years. Exclusionary criteria included exclusive pediatric onset of symptomatology attributable to GPAVFs without a new onset major presentation during adulthood, exclusive or major dural arterial supply, arteriovenous malformations with Galenic drainage, developmental venous anomalies with Galenic drainage, isolated varices or anomalies of the vein of Galen, and any lesions with uncertainty regarding true GPAVF nature.
Our search generated 1589 articles. Excluding duplicates, 26 cases met criteria for evaluation. Mean age was 34.1 +/− 2.53 years. Clinical presentations of GPAVFs among adults included headache, intracranial hemorrhage, seizures, and focal neurologic deficits. Management strategies included observation (n = 5), emergent ventriculostomy or Torkildsen shunt (n = 3), cerebrospinal fluid diversion via ventriculoperitoneal shunting (n = 4), microsurgical obliteration or thrombectomy (n = 4), transarterial and/or transvenous embolotherapeutic obliteration (n = 7), and concurrent embolotherapy and radiosurgical irradiation (n = 1).
GPAVFs in adults often present with symptomatology of mild severity and may be effectively managed conservatively, though occasionally present catastrophically or may be treated via cerebrospinal fluid diversion, microsurgical obliteration, or endovascular embolization. Severity sufficient to require emergent intervention portended a poor outcome.
•Galenic pial arteriovenous fistulae (GPAVFs) present insidiously in adult.•Asymptomatic GPAVFs may be serially observed.•GPAVFs causing symptoms may be obliterated endovascularly.•Hemorrhagically ruptured GPAVFs may be subjected to operative intervention.•Further studies are necessary in order to prospectively evaluate lesion natural history.
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Details
- Title
- Galenic Pial Arteriovenous Fistulas in Adults
- Creators
- Michael George Zaki Ghali - Karolinska InstituteUlf P. Arborelius - Karolinska InstituteErol Veznedaroglu - Neurosciences InstituteRobert F. Spetzler - Barrow Neurological InstituteM. Gazi Yaşargil - University Hospital of ZurichVitaliy Marchenko - Bogomoletz Institute of Physiology
- Publication Details
- Journal of the neurological sciences, v 416, 117014
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology; Neurosurgery
- Web of Science ID
- WOS:000596476500048
- Scopus ID
- 2-s2.0-85087502757
- Other Identifier
- 991019168367304721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Neurosciences