Endovascular treatment of vein of Galen aneurysmal malformation.

A 25-year-old man was referred toour emergency department withhead trauma due to a car accident.His medical history was uneventfuland physical examination on the firstaid department revealed no neuro-logical disorders. Because of thehigh energetic trauma a CT scanof the head was performed whichexcluded fractures or cerebral trau-matic changes, however, did show alarge hyperdense lesion located atthe pineal gland region with multipleaneurysmal malformation (VGAM)with two arterial feeders originatingfrom the right PCA; the median andlateral choroidal artery, fistulatingwith the large aneurysm (Fig. 3).Thislarge fistula resulted in a steal phe-nomenon with decreased blood flowin the PCA and the right middle cere-bral artery through a hypertrophicposterior communicating artery. There was also some steal fromthe right anterior cerebral artery,however since the right A1 segmentwas hypoplastic, the right anteriorcirculation was mainly fed by the leftirregular calcifications (Fig. 1). Thedifferential diagnosis included apineal gland tumor, falx meningeo-ma or large vascular malformation.MRI showed that the lesion wascharacterized by a flow void, corre-sponding to a strongly dilated veinof Galen (Fig. 2). Hypertrophic feed-ers from the right posterior cerebralartery (PCA) could be identified sug-gesting the diagnosis of a vein ofGalen malformation.In this patient a digital subtractionangiography (DSA) was performedshowing a large vein of GalenJBR–BTR, 2009, 92: 25-28.