Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2019; 7(7): 855-862
Published online Apr 6, 2019. doi: 10.12998/wjcc.v7.i7.855
Vein of Galen aneurismal malformations - clinical characteristics, treatment and presentation: Three cases report
Peter Spazzapan, Zoran Milosevic, Tomaz Velnar
Peter Spazzapan, Tomaz Velnar, Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Zoran Milosevic, Department of Radiology, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Author contributions: All authors contributed equally to this work; Spazapan P designed the research; Milosevic Z analysed the data; Velnar T collected the data; Spazzapan P, Milosevic Z and Velnar T wrote the paper.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tomaz Velnar, MD, PhD, Assistant Professor, Doctor, Department of Neurosurgery, University Medical Centre Ljubljana, Zaloska 7, Ljubljana 1000, Slovenia. tvelnar@hotmail.com
Telephone: +386-1-5223250 Fax: +386-1-5222218
Received: November 21, 2018
Peer-review started: November 21, 2018
First decision: December 29, 2018
Revised: January 21, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 6, 2019
Processing time: 137 Days and 0.7 Hours
Abstract
BACKGROUND

The vein of Galen aneurismal malformations (VGAM) are rare arteriovenous malformations of the embryonic choroid plexus. They represent about 30% of paediatric neurovascular disorders and show diverse characteristics. The VGAM is constituted by a midline dilated venous structure that receives blood from abnormal macroscopic or microscopic arteriovenous shunting vessels. Two types of VGAM exist, the choroidal and the mural. The treatment represents a challenge with the therapeutic objective to preserve the normal brain development without creating new neurological deficits.

CASE SUMMARY

We present three cases of VGAM in the early postnatal period and their treatment. All patents were treated with the endovascular technique, which was successful. According to our experience, the endovascular technique is a safe and efficient mode of VGAM treatment.

CONCLUSION

The objective of treatment aims to child’s normal neurological development. A proper selection of patients and a thorough diagnostic workup is of vital importance. When the endovascular treatment is performed, the primary aim is not a complete VGAM exclusion at one time, which could produce a sudden reversal of blood flow with consequent venous infarction and ischemia. The aim is therefore to occlude as much of the VGAM as needed to relieve the congestive cardiac failure, to gain time and to create the conditions for a normal maturation of the neurovascular system. With the use of endovascular techniques, which represent not only the first choice of treatment but also the only safe therapeutic modality, the natural history of VGAM and their risks may be avoided safely.

Keywords: Vein of Galen; Aneurismal malformation; Children; Treatment; Case reports

Core tip: The vein of Galen aneurismal malformations are rare arteriovenous malformations of the embryonic choroid plexus. Their treatment represents a big challenge with the therapeutic objective to preserve the normal brain development without creating new neurological deficits.