Endovascular remodeling technique for vein of Galen aneurysmal malformations––angiographic confirmation of a connection between the median prosencephalic vein and the deep venous system

Abstract

<jats:p>✓ It is commonly believed that in vein of Galen aneurysmal malformations (VGAMs) venous structures normally constituting the deep or Galenic venous system, such as the internal cerebral vein (ICV) and the basal vein of Rosenthal, are not connected to the vein of Galen. In this report, the authors describe 2 cases of successfully treated VGAM in which drainage of an ICV into the vein of Galen was confirmed by follow-up angiography. Two mural types of VGAM were treated using transarterial glue embolization when 1 child was 5 months and the other was 6 months old. The postoperative outcomes for these babies were complete cures. Follow-up digital subtraction angiography obtained after 12 months (Case 1) and 6 months (Case 2) confirmed that the shrunken median prosencephalic vein connects with the deep venous system. The possibility of normal deep Galenic venous drainage must be considered in endovascular management of VGAM. The goal of endovascular intervention is to close only the ventral component of the dilated median prosencephalic vein.</jats:p>

Vein of Galen aneurysmal malformation—clinical and angiographic spectrum with management perspective: an institutional experience

“…Similar findings were also reported by Levrier et al 15 and Iizuka et al 16 In fact, this connection could be the reason for the fatal IVH in our cases where the venous sac was rapidly occluded. Lasjaunias et al 4 denied the possibility of a deep venous connection of the venous sac.…”

Outcome and complications of endovascular embolization for vein of Galen malformations: a systematic review and meta-analysis

“…The key aim of endovascular therapy of VGAM is to occlude the arteriovenous fistula and try to avoid damaging the venous drainage system. 27 Given the deep lesion site, complex structure, and difficult surgery, such factors are likely to cause cerebral hemorrhage, even leading to death. This is due to a sudden reversal of blood steal resulting in excessive blood perfusion syndrome.…”

Spontaneous Occlusion of a Vein of Galen Malformation: A Case Report and Proposed Mechanism

“…2,6,12,37 In addition, papers show resolution of hydrocephalus from embolization alone and thus no shunting was required. 3,36,38 Pearl et al recommend staging the embolization to prevent breakthrough hemorrhages from rerouting high blood pressure to ischemic areas. 36 When reviewing historical papers on VGMs prior to endovascular therapies, there were high morbidities and mortalities.…”