# Vein of Galen Malformation—Experience of the Last 13 Years in a Reference Center from South-Eastern Europe

## TL;DR

This paper reviews 9 cases of vein of Galen malformations in newborns over 13 years, focusing on treatment approaches and outcomes in a European reference center.

## Contribution

The study provides clinical insights into managing vein of Galen malformations in a region with limited endovascular treatment options.

## Key findings

- Most patients experienced liver failure and pulmonary hypertension due to high-output heart failure.
- Half of the newborns had neurological anomalies from impaired cerebral hemodynamics.
- Tailored intensive care was crucial for maintaining stability until curative intervention could be performed.

## Abstract

The vein of Galen malformations (VoGMs) is mainly correlated with the retention of an embryonic pattern of vascularity, inducer of vein of Galen dilation, and formation of arteriovenous communications that give rise to the risk of systemic shunting, causing cardiac dysfunction, vascular steal, and venous hypertension. This is a rare cerebral vascular malformation in the newborn, accounting for 1% of all cerebral arteriovenous malformations and occurring in approximately 1 in 25,000–50,000 live births. We review nine cases of newborns diagnosed with vein of Galen malformations (VoGMs) to assess whether this pathology demonstrates a marked improvement over the past 13 years in diagnostic accuracy, treatment approaches, and patient survival rates within our clinic. Medical treatment was focused on providing inotropic support and tightly controlled peripheral and pulmonary vasodilation with the aim of overriding the effects of high output heart failure. Most of the patients underwent liver failure and flow-mediated pulmonary hypertension, while half of the newborns expressed anomalies of the nervous system due to impaired cerebral hemodynamics. Given the unavailability of endovascular treatment in our unit, which predisposes the newborns to a higher vital risk, we recognize the importance of delivering tailored intensive care aimed at maintaining cardiorespiratory and hemodynamic stability until a curative intervention can be performed in a specialized center.