Endoscopic Treatment of Hydrocephalus Due to Aneurysm of the Vein of Galen: Case Report and Literature Review

Feletti, Alberto; Denaro, Luca; Marton, Elisabetta; D’Avella, Domenico; Longatti, Pierluigi

doi:10.1055/s-2007-990294

Cited by 18 publications

(5 citation statements)

References 21 publications

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“…ETV has been found to be successful in huge hydrocephalus in vein of Galen aneurism. [14] Syringomyelia with or without Chiari malformation Type I Chiari malformations refer to a spectrum of congenital hindbrain abnormalities affecting the cerebellum, brainstem, the upper cervical cord and the bony cranial base. Hydrocephalus occurs in 7% -10% of patients with Chiari I malformation (CIM).…”

Section: Congenital Aqueductal Stenosismentioning

confidence: 99%

Endoscopic third ventriculostomy

Yadav

Parihar

Pande

et al. 2012

Journal of Neurosciences in Rural Practice

102

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Endoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of long term follow up.

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Section: Congenital Aqueductal Stenosismentioning

confidence: 99%

Endoscopic third ventriculostomy

Yadav

Parihar

Pande

et al. 2012

Journal of Neurosciences in Rural Practice

102

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“…Endoscopic third ventriculostomy has been described in a single case report for the treatment of hydrocephalus in an adult patient with a partially thrombosed vein of Galen malformation [19]. The etiology for hydrocephalus in this case is almost certain to be mechanical obstruction at the level of the aqueduct.…”

Section: Discussionmentioning

confidence: 97%

The High Risks of Ventriculoperitoneal Shunt Procedures for Hydrocephalus Associated with Vein of Galen Malformations in Childhood: Case Report and Literature Review

et al. 2010

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Little to no pediatric or neurosurgical literature has been published about the complications of ventriculoperitoneal shunt procedures for hydrocephalus associated with vein of Galen malformations in childhood. The interventional neuroradiology literature, however, suggests that ventriculoperitoneal shunting as first-line treatment for hydrocephalus in children with vein of Galen malformations is fraught with short- and long-term dangers, including status epilepticus, intraventricular hemorrhage, subdural hematoma and hygroma, venous infarction, malignant dystrophic calcification, and worsening developmental delay. We present a single pediatric case where a ventriculoperitoneal shunt procedure for symptomatic hydrocephalus seemed to be the major contributing factor to the rapid neurological deterioration and eventual death of an infant with a vein of Galen malformation. Based on this experience and our review of the literature, we suggest the use of endovascular embolization of the vein of Galen malformation to reestablish a balance in hydrovenous dynamics as first-line treatment rather than directly addressing hydrocephalus with CSF diversion. The ventriculoperitoneal shunt procedure should be reserved for cases with symptomatic hydrocephalus in which the patient is a poor candidate for embolization, or for cases where endovascular therapy has already been maximized. The role of endoscopy in the treatment of hydrocephalus associated with vein of Galen malformations is not clear.

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“…Similarly, endoscopic third ventriculostomy (ETV) is not recommended in infants with VGAM. Although shown to be successful in a single case report of an adult patient with VGAM, the use of ETV in infants with VGAM-associated hydrocephalus is conceptually flawed [68]. Firstly, ETV is only a viable treatment option for hydrocephalus resulting from an obstruction that is distal to the third ventricle.…”

Section: Management Approachesmentioning

confidence: 99%

Advances in the diagnosis and management of vein of Galen malformations

Abruzzo

Jimenez

Ostling

et al. 2015

J Pediatr Neuroradiol

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The vein of Galen malformations are a heterogeneous group of developmental arteriovenous shunt lesions characterized by arterialization of the early embryonic choroidal venous circulation. The arteriovenous shunt lesion manifests a spectrum of age dependent clinical phenotypes each of which expresses a wide range of disease severity. Clinical presentation is determined by lesion specific, host specific and environmental factors. In recent years, patient oriented treatment strategies directed at optimizing cardiovascular and neurodevelopmental outcomes have evolved. Treatment is tailored to address specific clinical phenotypes that are differentiated according to their pathophysiology. This paper will review current approaches to the diagnosis and treatment of vein of Galen malformations patients emphasizing clinical phenotypes of the fetus, neonate and infant.

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Endoscopic Treatment of Hydrocephalus Due to Aneurysm of the Vein of Galen: Case Report and Literature Review

Cited by 18 publications

References 21 publications

Endoscopic third ventriculostomy

Endoscopic third ventriculostomy

The High Risks of Ventriculoperitoneal Shunt Procedures for Hydrocephalus Associated with Vein of Galen Malformations in Childhood: Case Report and Literature Review

Advances in the diagnosis and management of vein of Galen malformations

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