The treatment depends on a few factors two of which include the size of the vein of Galen malformation and the extent of the congestive heart failure. The patient will often die if the high output heart failure is the presenting feature without treatment. If the malformation is large the patient will rapidly deteriorate with progressively worsening cardiac failure however with a smaller malformation the heart failure will present later on in life and the patient usually presents with “failure to thrive” and developmental delay.
An embolisation is a procedure in which the feeding blood vessels to the malformation are intentionally closed. Embolisation aims to reduce blood flow to the vein of Galen malformation by obstructing feeding blood vessels. During the procedure a narrow catheter is fed through the arteries that lead to the malformation. The catheter enters the arteries usually through the groin and is fed up through the body and into the head where the malformation is located. Interventional neuroradiologists introduce materials that block the blood flow through the malformation and promote a clot formation that closes it off. The materials used can vary from a kind of fast acting surgical glue to small particles or coils. The procedure is not often fully completed on the first try but by gradually closing off remaining areas of veins in subsequent efforts, Interventional neuroradiologists can usually shut down the malformation. By shutting down the malformation the blood flow through the body can return to a normal rate and will correct the congestive heart failure and the pressure that this created on the other vital organs.
If the malformation is large and complex the patient may require several sessions of embolisation in order to close the malformation and reduce blood flow, keeping the patient out of heart failure. While the malformation is not completely closed off the patient may have some areas of developmental delay. Medical research shows that once the malformation is closed off the patient should catch up to development of his or her peers. In addition, children who do not develop heart failure as result of the disease fair particularly well.