Vein of Galen aneurismal malformations - clinical characteristics, treatment and presentation: Three cases report

Figure 1 Imaging examinations of patient 1. A: Chest x-ray with cardiomegaly. The arrows indicate the outlines of cardiac silhouette; B-E: The MRI showing a 22 mm x 14 mm choroidal VGAM (red arrow pointing on the malformation). The scale indicates 2 cm; F: Angiography showing the feeders originating from the posterior choroidal and pericallosal arteries (red arrows) with the characteristic persistent limbic ring (black arrows). The scale indicates 1 cm; G-I: The partially occluded VGAM after an endovascular transarterial embolization with coils, which are visible in the malformation; J-L: A control MRI 15 mo after treatment. Almost complete thrombosis of the VGAM (J and K) with a good venous drainage (arrows) toward the sagittal, transverse and sigmoid sinuses may be seen (L).

Figure 2 Imaging examinations of patient 2. A: The chest x-ray showing dilatation of the right heart (red arrows indicate the heart silhouette) and lung oedema (white spots in the lung parenchima); B,C: The MRI showing a 35 mm × 45 mm VGAM (thick arrow) with main feeders arising from both posterior cerebral arteries, posterior communicating arteries, anterior choroidal arteries and callosomarginal arteries (thin arrows). The VGAM drains into a persistent falcine sinus (white arrow) (C). The scale indicates 1 cm; D, E: A control MRI one year after treatment. No residual flow through the VGAM can be seen.

Figure 3 Imaging examinations of patient 3. A: The MR angiography one year after treatment showed mild ventricular dilatation, especially of the left occipital horn; B: No residual flow in the VGAM is seen. The VGAM was occluded completely.