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Cranial Doppler ultrasound in Vein of Galen malformation

  • Interventional Neuroradiology
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Abstract

Introduction

Vein of Galen malformation (VGM) is the severest paediatric neurovascular disease usually requiring multiple staged embolisations. In the high-risk group of children with high-flow arteriovenous shunts, timing of treatment is uncertain. Low Doppler resistance index (RI) is known to be associated with adverse outcome in hypoxic-ischaemic brain injury in children. In this study, we want to present our long-term results of cranial transfontanellar Doppler ultrasound in children with VGM.

Methods

We identified and retrospectively analysed 264 transfontanellar Doppler measurements in 19 endovascular-treated true VGM (five females, 14 males) between 2000 and 2013. The recordings were obtained from the internal carotid arteries (ICA), the anterior cerebral arteries (ACA) and the basilar arteries (BA). Maximal systolic velocity (Vs), end-diastolic velocity (Ved) and the RI were measured before and after embolisation.

Results

Untreated, nearly all cases showed pathologic high systolic (up to >1.0 m/s), very high diastolic velocities (up to >0.5 m/s) and low RI (<0.6). There were statistically significant differences (p = 0.012) between the pre-embolisation RI and the post-embolisation RI with pathologic low RI before and nearly normal RI after successful shunt reduction.

Conclusion

Successful endovascular shunt reduction in VGM leads to significant changes of cranial Doppler RI from pathologic low values to normal values. We propose cranial Doppler ultrasound as an adjunctive technique to other screenings in the management of VGM. Further research is warranted to evaluate the role of the RI in the treatment timing decision.

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Ethical standards and patient consent

We declare that this manuscript does not contain clinical studies or patient data.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany

    Dan Meila & Heinrich Lanfermann

  2. Department of Radiology and Neuroradiology, Klinikum Duisburg – Sana Kliniken, Duisburg, Germany

    Dan Meila, Kathrin Lisseck & Friedhelm Brassel

  3. Department of Orthodontics, University of Mainz, Mainz, Germany

    Collin Jacobs

  4. Department of Pediatrics, Klinikum Duisburg – Sana Kliniken, Duisburg, Germany

    Axel Feldkamp

Authors
  1. Dan Meila
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  2. Kathrin Lisseck
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  3. Collin Jacobs
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  4. Heinrich Lanfermann
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  5. Friedhelm Brassel
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  6. Axel Feldkamp
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Corresponding author

Correspondence to Dan Meila.

Additional information

Dan Meila and Kathrin Lisseck contributed equally to this work.

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Meila, D., Lisseck, K., Jacobs, C. et al. Cranial Doppler ultrasound in Vein of Galen malformation. Neuroradiology 57, 211–219 (2015). https://doi.org/10.1007/s00234-014-1455-7

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  • DOI: https://doi.org/10.1007/s00234-014-1455-7

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