Periprocedural Management of Vein of Galen Aneurysmal Malformation Patients: An 11-Year Experience

CONTEXT: The vein of Galen aneurysmal malformation (VGAM) is a rare arteriovenous malformation where a dilated median prosencephalic vein provides a low-resistance conduit for intracerebral blood flow resulting in high-output cardiac failure, severe pulmonary hypertension, with or without central nervous system symptoms secondary to hydrocephalus, in the neonatal and pediatric population. AIM: This study aims to analysis of the anesthetic management of this unique subset of patients with VGAM. SETTINGS AND DESIGN: This was a retrospective analysis of case series of VGAM patients admitted between January 2005 and June 2016 in our Institute. SUBJECTS AND METHODS: Case records of VGAM patients were reviewed for the anesthetic technique and medications administered. The incidence of intra-and post-procedural complications and their management and outcomes were analyzed. STATISTICAL ANALYSIS: Parametric data were expressed as mean and standard deviation. Descriptive statistics was used for describing associated pathologies, drugs and monitors used during the procedure, incidence of any adverse events, and the treatment protocol. RESULTS: Twenty-one patients underwent treatment for the VGAM. There were a total of forty anesthetics administered for embolization, diagnostic angiography, and magnetic resonance imaging. Eighty-five percent had increased head circumference, 40% had associated focal neurological deficits, and 15% had seizures as presenting symptoms. Cardiac anomalies were seen in 41% of the patients, and difficult airway was anticipated in 38% of the patients. The majority of the patients had inhalational induction (62.2%) and inhalation maintenance (84.4%) of anesthesia. Intraprocedural adverse events were noted in 43% and postprocedure complications in 38% of the patients. CONCLUSION: Anesthetic management for embolization of VGAM with a combination of opioids and inhalational agents helps in minimizing the incidence of intraprocedural adverse events and provides a better hemodynamic profile.