Other venous anomalies commonly co-occur with VGAM, including anomalous dural sinuses, sinus stenoses, and an absence of the straight sinus (1, 2, 5).
(8) classified VGAM into five different types, including parenchymatous AVM in 44%, choroidal AVM in 30%, mural AVM in 20%, vein of Galen varices in 7%, and dural AVM in 3% of cases, and reported that the pediatric population was particularly most sensitive to this shunt, regardless of the type (9).
VGAM can cause severe morbidity and mortality, particularly in neonates, but also in infants and older children.
Thus, VGAM must be considered in all children presenting with macrocephaly.
The problem is that at that point the vehicle might be launched into the air by the blast--when the ABBS system comes into action, the VGAM
being based on novel fast-acting, powerful rocket motors that apply a downforce on the vehicle to negate upward acceleration.
We thank Bernard Salanie and Andreas Richter for valuable comments and discussions, and Thomas Yee for assistance in applying the R package VGAM
. We are grateful to participants of the EEA/ESEM annual meeting 2011 in Oslo, of the annual conference of the German Economic Association (VfS) 2011 in Frankfurt am Main and of the annual seminar of the EGRIE 2011 in Vienna.
The most common presentation of VGAM is in babies who are diagnosed with congestive heart failure soon after birth.
The Bicentre Neonatal Score (Table 1) is used to define the required clinical and imaging procedures to effectively assess the VGAM lesion, the infant's physiological response to it, and the urgency and likely outcome of treatment (Lasjaunias et al., 2006).
Surgical attempts to close VGAM have a high mortality or severe morbidity, therefore embolisation by the neuroradiology team is the only way to treat neonates with VGAM who do not respond adequately to medical treatment (Bhattacharya & Thammoroj, 2003).
These findings were confirmed on magnetic resonance imaging (MRI), angiography (MRA) and magnetic resonance venography (MRV) (Figs 1b, 3a, 3b.) Digital substraction angiography (DSA) confirmed a mural type of VGAM supplied by the left posterior medial choroidal artery.
A micro-catheter was advanced into the posterior medial choroidal artery approximately 1.5 cm from the fistula leading to the VGAM. A solution of 96% histo-acryl glue in Lipiodol with tantalum powder was injected through the micro-catheter.
VGAM is divided into choroidal and mural types, based on the arterial supply.