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.
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.
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).
Ideally the initial treatment of VGAM is conservative and where possible the infant is treated medically with diuretics, beta-blockers to decrease the work load of the heart and good nutirtion (Landsman & Roberts, 2011).
The second option for treatment of the VGAM is embolisation.
Above all management of neonates and children with VGAM requires a team approach involving foetal medicine, neonatology, paediatric cardiology, intensive care, neurology, neurosurgery and interventional neuroradiology.
When Fraser was diagnosed with VGAM he was two days old, and by this time he was intubated and arrangements were being made for an air-ambulance transfer to Starship Children's Hospital in Auckland -the only New Zealand centre able to treat babies with this condition.
VGAM is divided into choroidal and mural types, based on the arterial supply.
VGAM must be distinguished from vein of Galen aneurysmal dilatation (VGAD).
Presentation of VGAM depends on the age of the patient.
After 30 weeks' gestation, VGAM can be detected sonographically as a midline supratentorial cystic mass posterior to the third ventricle demonstrating high-velocity turbulent flow on colour Doppler.
3,4) Shunting is associated with haemorrhage from the dilated superficial veins in VGAM.