Pseudofeeders on fetal magnetic resonance imaging predict outcome in vein of Galen malformations

Objective Although vein of Galen aneurysmal malformations (VGAM) can be diagnosed in the fetus, the challenge is predicting the occurrence of its 2 major complications: cardiopulmonary failure and encephalomalacia. This study attempts to determine which fetal brain magnetic resonance imaging (MRI) features might be used to predict the development of these complications at birth. Methods The cohort was extracted from a prospectively assembled database of VGAM cases managed at a single referral center from 2000 to 2014. Of 251 patients with VGAM, 83 cases were diagnosed prenatally. A total of 58 patient charts having at least 1 fetal MRI were reviewed. Patterns of brain parenchyma, hydrocephalus, and so‐called middle cerebral artery (MCA) “pseudofeeders” were correlated with cardiac failure, pulmonary hypertension, and encephalomalacia at birth. Results The median gestational age at fetal MRI was 32.3 weeks of pregnancy (±2.3). Nine fetuses (16%) had encephalomalacia. Thirty‐one fetuses (53%) had MCA pseudofeeders. Twenty‐six fetuses (45%) had prenatal hydrocephalus. Prenatal MCA pseudofeeders were a risk factor for encephalomalacia at birth ( p = 0.001). MCA pseudofeeders and hydrocephalus were risk factors for both severe cardiac failure ( p = 0.01 and p = 0.04, respectively) and severe pulmonary hypertension ( p = 0.014 and p = 0.05, respectively) at birth. Interpretation MCA pseudofeeders are the result of impaired cerebral blood flow, and are thus a risk factor for further brain melting at birth. Their presence can be used for informing parents and as an aid in management decisions. Ann Neurol 2017;81:278–286