A0045 Anesthetic Management of Patients Presenting with Vein of Galen Malformation for Endovascular/Surgical Treatment: A 10-Year Retrospective Analysis

Background: The vein of Galen aneurysmal malformation (VGAM) is a rare arteriovascular malformation in which 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 CNS symptoms secondary to hydrocephalus, in the neonatal and pediatric population. Anesthetic management of these patients proves challenging due to the risk of periprocedural complications like congestive cardiac failure, pulmonary edema, and cerebral infarction. We report a retrospective analysis of the anesthetic management of this unique subset of patients with VGAM.

Materials and Methods: Case records of VGAM patients admitted between January 2005 and December 2015 were reviewed for the anesthetic technique and medications were administered. The incidence of intra and postprocedural complications and their management and outcomes were analyzed.

Results: Twenty-one patients underwent treatment for VGAM during this 11-year period. There were a total of 40 anesthetics inclusive of anesthesia administered for the embolization procedure, anesthesia for diagnostic MRI, and anesthesia for follow-up check digital subtraction angiographies (DSA). Intraprocedural adverse events occurred in 7 of the 40 anesthetics (17.5%).

Conclusions: VGAMs are a rare presentation with neurological deficits, difficult airways, and complex cardiorespiratory status. Due to the advances in monitoring of the cardiorespiratory system and newer anesthetic drugs, majority of these patients have uneventful and safe anesthetics. Caution and alertness can help to improve the identification and early treatment of intra- and postprocedural complications.