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Introduction: Vein of Galen aneurysmal malformation (VGAM) is a severe pediatric neurovascular disease. Children often present with congestive heart failure in the neonatal period. In the last decades, endovascular treatment became the first therapeutic option. The purpose of this study is to report our results in the treatment of VGAM with a combined transvenous and transarterial method in the last ten years., Methods: In our cohort of 28 patients with VGAM, 22 patients were treated endovascularly between 1992 and 2010. In the last 10 years, a consecutive series of 14 children were treated with a combined transvenous and transarterial method. The therapeutic goal was immediate shunt reduction of the arteriovenous malformation, especially in the neonatal period. Closure of the fistulous connections was achieved by coiling using a combined transvenous and transarterial approach, called "kissing microcatheter technique"., Results: Eight of 14 children presented in the neonatal period with severe congestive heart failure. The other six patients presented between the age of 2 and 17 months. One patient died due to a non-procedural complication in another hospital 2 years after the last treatment. Complete or >90% of angiographically confirmed closure of the malformation was documented in 11 of 14 patients. Normal or near-normal outcome was achieved in 9 of 13 surviving children, a non-favorable outcome was observed in four children. Control of heart failure was achieved in all patients., Conclusion: Endovascular treatment of VGAM using a combined transvenous and transarterial method is a safe procedure with a low complication rate. The overall outcome can be improved, especially in the high-risk neonatal group with congestive heart failure.

Purpose: To evaluate the sensitivity of 16-detector row computed tomographic (CT) angiography in diagnosis of intracranial aneurysms and to determine whether multidetector CT angiography provides sufficient diagnostic information to guide endovascular treatment, with combined imaging and clinical data as the reference standard., Materials and Methods: Institutional review board approval and informed consent were obtained. Eighty-seven patients clinically suspected of having subarachnoid hemorrhage underwent multidetector CT angiography and digital subtraction angiography (DSA). Aneurysm detection with multidetector CT angiography and DSA was analyzed on a per-patient and a per-aneurysm basis. For each aneurysm deemed ruptured on multidetector CT angiograms, the same multidetector CT angiography data set was used to determine whether the aneurysm was suitable for endovascular coil placement or whether a neurosurgical procedure was preferable. Criteria were based on neck width in relation to aneurysm size and the presence of vessels originating from the aneurysm. Results were compared with actual treatment that had been performed in each aneurysm after full diagnostic work-up, including DSA. Sensitivity, specificity, and positive and negative predictive values for aneurysm presence were determined., Results: The reference standard revealed 84 aneurysms in 63 patients. Multidetector CT angiography was used to correctly identify 62 of 63 patients with 80 of 84 aneurysms and to correctly rule out aneurysms in 24 patients. DSA was used to correctly identify 62 of 63 patients with 79 of 84 aneurysms and to correctly rule out aneurysms in 23 patients. Per patient, the sensitivity, specificity, and positive and negative predictive values, respectively, for presence of aneurysm(s) were 98%, 100%, 100%, and 96% for multidetector CT angiography and 98%, 100%, 98%, and 96% for DSA. Per aneurysm, the possibility of coil embolization was correctly assessed with multidetector CT angiography in 69 (93%) of 74 target aneurysms for acute occlusive treatment., Conclusion: Multidetector CT angiography offers high diagnostic accuracy-equivalent to that of DSA-in the detection of intracranial aneurysms. Also, the possibility of coil embolization can be reliably determined with multidetector CT angiography.

Digital subtraction angiography (DSA) is still considered the gold standard for most applications in neurovascular imaging. However, with the ongoing development of cross-sectional imaging modalities DSA is increasingly being replaced by less invasive methods. This contribution describes the diagnostic value and the increasing potential of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the diagnosis and follow-up of intracranial aneurysms. The main role of CTA is in the diagnosis and therapy planning of ruptured aneurysms; in contrast, MRA plays an increasingly important role in the screening for asymptomatic aneurysms (especially in cases of familial subarachnoid hemorrhage) and in the follow-up after endovascular therapy with coils and/or intracranial stents. Technical issues concerning examination technique are covered here as well as an approach to advanced postprocessing of the image data. Furthermore, a brief outlook on the impact of new developments (MRA with parallel imaging and at 3.0 T) is given.