Fetal Treatment of Galenic Malformations
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Darren Orbach, MD PhD
- Phone Number: 617-355-5012
- Email: Darren.Orbach@childrens.harvard.edu
Study Locations
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Massachusetts
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Boston, Massachusetts, United States, 02115
- Boston Children's Hospital
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Pregnant woman carrying a fetus harboring a vein of Galen malformation in whom the straight sinus or falcine sinus draining the prosencephalic varix measures 7 mm or more on fetal MRI (medio-lateral diameter measured at the narrowest point of the sinus along the rostral-caudal axis, assessed on a T2-weighted coronal slice).
- Fetal gestational age between 23 weeks and term as determined by clinical information and evaluation of first ultrasound.
- Anatomic diagnosis of fetal vein of Galen malformation.
- Well preserved brain parenchyma.
- Maternal age of 18 years and older.
- Eligible for continuous lumbar epidural anesthesia.
- Able to travel to study site for study evaluation, procedures and visits.
Exclusion Criteria:
- Extensive fetal brain parenchymal injury/gliosis, >10% of supratentorial brain volume (i.e., SFP presentation). This is a degree of fetal brain injury beyond which the risk of significant neurological morbidity is high, based on studies of prenatal ischemic stroke.
- Irreversible fetal non-brain organ injury (e.g. hydrops fetalis as a manifestation of heart failure, a finding which portends fatal outcome in fetuses with vein of Galen malformation), i.e., SFP presentation.
- Fetus with VOGM in whom the straight sinus or falcine sinus draining the prosencephalic varix measures less than 7 mm on fetal MRI (T2-weighted coronal slice, medio-lateral diameter measured at the narrowest point of the sinus along the anterior-posterior axis), fitting fetal MRI criteria for likely evolution into the IT cohort.
- Severe maternal obesity pre-pregnancy as defined by body mass index (BMI) of 40 or greater.
- Fetuses with major congenital anomalies.
- Evidence of preterm labor, rupture of membranes or abruption.
- Maternal coagulopathy: INR > 1.2; PT/PTT above normal ranges for the lab; platelets <100.
- Medical disease requiring current anticoagulation including maternal deep vein thrombosis.
- Prior maternal medical history that would preclude epidural anesthesia.
- Multi-fetal pregnancy.
- Placenta previa or accreta.
- Participation in another fetal study that influences maternal and fetal morbidity and mortality.
- Known maternal hypersensitivity to 316LM stainless steel.
- Supine hypotensive syndrome.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Experimental: Fetal embolization of vein of Galen malformation
This is a single-arm study.
Fetal subjects will undergo a one-time intervention of fetal embolization of vein of Galen malformation.
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The study involves a single fetal intervention of maternal transuterine, fetal transcranial torcular puncture and median prosencephalic vein embolization.
Detachable platinum coils (Target XL and XXL Detachable Coil, Stryker Neurovascular) will be used to pack the prosencephalic varix.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Prenatal Safety of Fetal Embolization for Patients With Vein of Galen Malformations
Time Frame: From fetal embolization to delivery
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The procedure is deemed safe if
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From fetal embolization to delivery
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Efficacy of Fetal Embolization for Patients With Vein of Galen Malformations
Time Frame: Within 30 days of birth
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The procedure is deemed efficacious if none of the following serious postnatal events occur within 30 days of birth:
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Within 30 days of birth
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Darren Orbach, MD PhD, Boston Children's Hospital
Publications and helpful links
General Publications
- See AP, Wilkins-Haug LE, Benson CB, Tworetzky W, Orbach DB. Percutaneous transuterine fetal cerebral embolisation to treat vein of Galen malformations at risk of urgent neonatal decompensation: study protocol for a clinical trial of safety and feasibility. BMJ Open. 2022 May 24;12(5):e058147. doi: 10.1136/bmjopen-2021-058147.
- Orbach DB, Wilkins-Haug LE, Benson CB, Tworetzky W, Rangwala SD, Guseh SH, Gately NK, Stout JN, Mizrahi-Arnaud A, See AP. Transuterine Ultrasound-Guided Fetal Embolization of Vein of Galen Malformation, Eliminating Postnatal Pathophysiology. Stroke. 2023 Jun;54(6):e231-e232. doi: 10.1161/STROKEAHA.123.043421. Epub 2023 May 4. No abstract available.
- Orbach DB, Shamshirsaz AA, Wilkins-Haug L, Guseh S, Krispin E, Tworetzky W, O'Leary B, Larson AM, Rangwala SD, Oushy S, See AP. In Utero Embolization for Fetal Vein of Galen Malformation. JAMA. 2025 Sep 9;334(10):878-885. doi: 10.1001/jama.2025.12363.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Estimated)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Vascular Diseases
- Cardiovascular Diseases
- Congenital Abnormalities
- Cardiovascular Abnormalities
- Nervous System Malformations
- Intracranial Arterial Diseases
- Vascular Malformations
- Arteriovenous Malformations
- Central Nervous System Vascular Malformations
- Intracranial Arteriovenous Malformations
- Congenital, Hereditary, and Neonatal Diseases and Abnormalities
- Vein of Galen Malformations
Other Study ID Numbers
Other Study ID Numbers
- IRB-P00034727
- 2020P000216 (Other Identifier: Partners Healthcare IRB)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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