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Neurovascular cases
Vein of Galen Aneurysmal
Malformation (VGAM)
Dr.. Guy Raphaeli
Dr
Neurology department
Interventional Neuroradiology unit
Rabin Medical Center,
Beilinson hospital, Petach Tikva
Illustrative case
A 15 YO male patient, history unremarkable, chronic
headaches, first-ever generalized seizure
CT (-)
T2
FLAIR
Left VA
ONYX Embolization of feeders
Control DSA 21 days
Control DSA 21 days
 The vein of Galen is located under the cerebral
hemispheres and drains the anterior and central regions of
the brain into the sinuses of the posterior cerebral fossa.
 Called also as The great cerebral vein is one of the large
blood vessels in the skull draining the cerebrum
 The veins of the deep structures of the brain normally drain
through the Galenic system
 Named for its discoverer, the Greek physician Galen.
 Aelius Galenus or Claudius Galenus (b. 129 AD, d. circa
200 AD), better known as Galen of Pergamon was a
prominent Roman (of Greek ethnicity) physician, surgeon
and philosopher.
 Galen
contributed
numerous
scientific
greatly
to
the
disciplines,
understanding
including
of
anatomy,
physiology, pathology, pharmacology, and neurology, as
well as philosophy and logic.
 Direct communication between a cerebral artery and a
cerebral
vein
results
from
a
congenital
vascular
malformation. The vein of Galen abnormality is the most
frequent arteriovenous malformation in neonates.
 It commonly presents in the neonatal period, although it
may present later, in early childhood.
 Typically, in the neonatal period, VGAM presents with
congestive heart failure, a cranial bruit, and marked
carotid pulses.
 Vein of Galen aneurysmal malformations (VGAM) are the
most common form of symptomatic cerebrovascular
malformation in neonates and infants
 The
VGAM
is
a
choroidal
type
of
arteriovenous
malformation involving the vein of Galen and is distinct
from an arteriovenous malformation with venous drainage
into a dilated, but already formed, vein of Galen.
 Aneurysmal malformations of the vein of Galen typically
result in high-output congestive heart failure or may
present with developmental delay, hydrocephalus, and
seizures
 High-output heart failure in the newborn resulting from the
decreased resistance and high blood flow in the lesion.
 Associated findings include cerebral ischemic changes
such as strokes or steal phenomena that result in
progressive hemiparesis.
 Hemorrhage from the malformation can occur, although
this is not a common finding. Finally, the malformation may
result in mass effects, causing progressive neurological
impairment. Alternatively, the malformation may cause
obstruction
of
hydrocephalus.
the
CSF
outflow
and
result
in
Epidemiology
 The incidence of the vein of Galen malformation is
unknown.
Mortality/Morbidity
 Infants often die if the high-output congestive heart failure
is the presenting feature.
 Macrocephaly usually improves following shunting for
hydrocephalus.
 A recent study of 21 neonates demonstrated that poor
outcomes included neurological manifestations at birth,
focal cerebral parenchymal changes, calcification of
cerebral tissue, tonsillar herniation, and two or more
arterial feeders.
 In infants with these features, consideration could be given
to withholding aggressive intervention
Geibprasert S et al. Childs Nerv Syst. Jan 2010
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