Abstract 083: Initial Angiogenesis in Vein of Galen Malformations Is Associated with Increased Symptomatic Burden

Abstract

Introduction Vein of Galen Malformations (VOGM) are congenital brain arteriovenous malformations which often present during the neonatal or infantile periods. While endovascular embolization is the recommended management for this pathology, a subset of VOGM patients present with pathologic angiogenesis which complicates endovascular therapy. Previous studies have shown that these patients require a greater number of embolizations to achieve cure, but it is unclear whether this radiographic finding is associated with differences in clinical presentation. Methods A single‐center retrospective review identified all patients with a Vein of Galen Malformation from January 2004 to May 2023. Patients were stratified into three groups based on the development and timing of angiogenesis during their treatment course: pre‐intervention angiogenesis, post‐intervention angiogenesis, and no angiogenesis. Clinical presentations, relevant imaging, radiographic data, and procedural details were reviewed. Results 178 patients with VOGM were identified. 38 patients were in the pre‐intervention angiogenesis group, 51 patients were in the post‐intervention angiogenesis group, and 89 patients were in the no angiogenesis group. Pre‐intervention angiogenesis patients were significantly older on presentation for initial angiogram than post‐intervention angiogenesis or no angiogenesis patients (p<0.05). At initial clinical presentation, patients with pre‐intervention angiogenesis demonstrated significantly greater developmental delay (p<0.05). This difference persisted after controlling for age at initial presentation. Patients presenting with angiogenesis either pre‐intervention or post‐intervention required more embolizations to achieve cure compared to patients who did not develop angiogenesis during their treatment course (p<0.05). Conclusion Patients with VOGM who present with pre‐intervention angiogenesis demonstrate significantly more serious neurologic symptoms on initial presentation, even after controlling for age at presentation. Given that patients with angiogenesis are often older on initial presentation and require more embolizations to be cured, early and timely treatment is likely necessary to mitigate the further progression of both the angiogenic network and any associated neurological symptoms.