Targeted neonatal echocardiography-guided management of high flow cerebral vascular malformations: Impact of a multidisciplinary neurohemodynamics team

Background and objective High-flow cerebral vascular malformations (HFCVM) are rare, life-threatening anomalies causing severe neonatal cardiorespiratory compromise. Targeted neonatal echocardiography (TNE) enables detailed hemodynamic assessment to guide stabilization and embolization timing. We evaluated a multidisciplinary, TNE-guided protocol to optimize individualized care and shorten shunting duration. Methods Single-center case series of five neonates with HFCVM admitted to a Level IV NICU (June 2022–June 2025). The protocol incorporated serial TNE for prenatal diagnosis, pre-/post-embolization care, and intra-procedural monitoring. TNE categorized cardiovascular phenotypes, guided embolization timing, and monitored cardiac function. Results Five neonates with HFCVM were managed using this protocol. Median number of embolizations per neonate were 2 (2.0–2.5). Four patients exhibited flow-mediated physiology with high cardiac output and ductal-dependent systemic perfusion. Four patients survived to discharge. One patient experienced a fatal intracranial hemorrhage. Conclusion A physiology-driven, TNE-guided approach for neonatal HFCVM is feasible and supports tailored hemodynamic management and staged embolization. Prospective multicenter validation is warranted.