In Utero Embolization for Fetal Vein of Galen Malformation

作者：Darren B. Orbach, Alireza A. Shamshirsaz, Louise Wilkins‐Haug, Stephanie Guseh, Eyal Krispin, Wayne Tworetzky, Brianna O’Leary, A. Noelle Larson, Shivani D. Rangwala, Soliman Oushy, Alfred P. See · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.12363 · 被引用次数：6 · 研究领域：Vascular Malformations Diagnosis and Treatment、Vascular Malformations and Hemangiomas、Cerebral Venous Sinus Thrombosis

Importance: Vein of Galen malformation (VOGM) is the most common congenital cerebrovascular anomaly. Fetuses with VOGM and wide mediolateral falcine sinus diameters are at high risk for mortality, brain injury, and neurodevelopmental delay. In utero embolization may improve survival and outcomes. Objective: To report early results from this institutional review board-approved single-group intervention study of in utero embolization for VOGM. Design, Setting, and Participants: Single-center, single-group intervention study in the US. First enrollment was on September 30, 2022; the most recent follow-up was on April 10, 2025. Eligible fetuses had VOGM, no major brain injury on fetal magnetic resonance imaging, and falcine sinus width of 7 mm or greater. Fetal embolization was ultrasound guided, using transuterine, transcranial needle access and microcatheterization of the prosencephalic venous varix with detachable coils. Intervention: In utero embolization of fetuses with VOGM. Main Outcomes and Measures: Neonatal mortality and neurodevelopmental outcomes. Pre- and postembolization fetal magnetic resonance imaging and echocardiography were performed. Results: Seven patients were enrolled; 5 underwent successful embolization. The mean maternal age was 32.4 years (range, 22-36); the mean fetal gestational age was 35 6/7 weeks (range, 33 6/7 to 37 1/7); and the sex ratio was 3:4 (female to male). The mean falcine diameter (10.3 mm) corresponded to 90% expected mortality and 9% li...