Vein of Galen Aneurysmal Malformation in a Neonate: A Case Report

Document Type : Case Report

Authors

1 Assistant Professor of Neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Neonatologist, Hashemi Nejad Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Assistant Professor of Pediatric Dentistry, Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

4 Professor of Neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Associate Professor of Neonatology, Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital malformation, accounting for less than 1% of cerebrovascular abnormalities. The majority of reported cases have been associated with congestive heart failure (CHF) in the neonatal period. Herein, we present a case of VGAM, diagnosed at 37 weeks of gestation during the intrauterine life
Case report: A full-term female newborn presented with severe CHF at two days of age. The patient's peripheral pulses were bounding in all four extremities. The first heart sound appeared to be normal, while the second had an accentuated pulmonic component. A systolic murmur (grade 3/6), best heard in the pulmonary area, was reported, and a cranial bruit was sought and found. The echocardiography showed evidence of right ventricular hypertrophy, while the chest X-ray indicated cardiomegaly with increased pulmonary vascularity. Moreover, echocardiography revealed dilation of the right heart chambers, a patent foramen ovale, severe tricuspid regurgitation, as well as a moderate-sized secundum atrial septal defect and a patent ductus arteriosus with right-to-left shunting. Transcranial ultrasound and contrast-enhanced CT scan of the brain detected a vein of Galen malformation. Magnetic resonance venography confirmed VGAM and identified the vessels feeding the aneurysm. Postnatal management included aggressive medical treatment of CHF. Transarterial embolization of the vessels feeding the aneurysm was suggested. However, the newborn succumbed to her disease on the following day.
Conclusion: VGAM, which is a rare cause of cyanosis and heart failure in newborns, can be clinically diagnosed via proper strategies. However, extensive distribution of aneurysm usually precludes surgical management and endovascular treatment.

Keywords

References

  1. Dandy WE. Experimental hydrocephalus. Ann Surg. 1919; 70(2):129-42.
  2. Raybaud CA, Strother CM, Hald JK. Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation. Neuroradiology. 1989; 31(2):109-28.
  3. Cumming GR. Circulation in neonates with intracranial arteriovenous fistula and cardiac failure. Am J Cardiol. 1980; 45(5):1019-24.
  4. Gupta AK, Rao VR, Varma DR, Kapilamoorthy TR, Kesavadas C, Krishnamoorthy T, et al. Evaluation, management, and long-term follow up of vein of Galen malformations. J Neurosurg. 2006; 105(1):26-33.
  5. Khullar D, Andeejani AM, Bulsara KR. Evolution of treatment options for vein of Galen malformations. J Neurosurg Pediatr. 2010; 6(5):444-51.
  6. Lasjaunias PL, Chng SM, Sachet M, Alvarez H, Rodesch G, Garcia-Monaco R. The management of vein of Galen aneurysmal malformations. Neurosurgery. 2006; 59(5 Suppl 3):S184-94.
  7. Pearl M, Gomez J, Gregg L, Gailloud P. Endovascular management of vein of Galen aneurysmal malformations. Influence of the normal venous drainage on the choice of atreatment strategy. Childs Nerv Syst. 2010; 26(10):1367-79.
  8. Halbach VV, Dowd CF, Higashida RT, Balousek PA, Ciricillo SF, Edwards MS. Endovascular treatment of mural-type vein of Galen malformations. J Neurosurg. 1998; 89(1):74-80.
  9. Lasjaunias P, Garcia-Monaco R, Rodesch G, Ter Brugge K, Zerah M, Tardieu M, et al. Vein of Galen malformation. Endovascular management of 43 cases. Childs Nerv Syst. 1991; 7(7):360-7.

10. Beucher G, Fossey C, Belloy F, Richter B, Herlicoviez M, Dreyfus M. Antenatal diagnosis and management of vein of Galen aneurysm: review illustrated by a case report. J Gynecol Obstet Biol Reprod (Paris). 2005; 34(6):613-9.

11. Rodesch G, Hui F, Alvarez H, Tanaka A, Lasjaunias P. Prognosis of antenatally diagnosed vein of Galen aneurismal malformations. Childs Nerv Syst. 1994; 10(2):79-83.

12. Mitchell PJ, Rosenfeld JV, Dargaville P, Loughnan P, Ditchfield MR, Frawley G, et al. Endovascular management of vein of Galen aneurismal malformations presenting in the neonatal period. AJNR Am J Neuroradiol. 2001; 22(7):1403-9.

13. Gailloud P, O'Riordan DP, Burger I, Levrier O, Jallo G, Tamargo RJ, et al. Diagnosis and management of vein of Galen aneurysmal malformations. J Perinatol. 2005; 25(8):542-51.

14. Nelson M, Dickinson DF, Wilson N. Transtorcular coil embolization of malformations of the vein of Galen--rapid resolution of heart failure in neonates. Int J Cardiol. 1988; 18(3):437–41.

15. Watson DG, Smith RR, Brann AW. Arteriovenous malformation of the vein of Galen: treatment in a neonate. Am J Dis Child. 1976; 130(5):520–5.

16. Friedman DM, Verma R, Madrid M, Wisoff JH, Berenstein A. Recent improvement in outcome using transcatheter embolization techniques for neonatal aneurismal malformations of the vein of Galen. Pediatrics. 1993; 91(3):583-6.

17. Gold A, Ransohoff J, Carter S. Vein of Galen malformation. Acta Neurol Scand Suppl. 1964; 40(Suppl 11):1-31.

18. Lasjaunias PL, Alvarez H, Rodesch G, Garcia-Monaco R, Ter Brugge K, Burrows P, et al. Aneurysmal malformations of the vein of Galen. Follow-up of 120 children treated between 1984 and 1994. Interv Neuroradiol. 1996; 2(1):15-26.

19.  Fullerton HJ, Aminoff AR, Ferriero DM, Gupta N, Dowd C. Neurodevelopmental outcome after endovascular treatment of vein of Galen malformations. Neurology. 2003; 61(10):1386-90.

Files

Share

How to cite

Statistics