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Images in Neurology |

Vein of Galen Aneurysmal Malformation Treated With Onyx

Panagiotis Papanagiotou, MD; Tilman Rohrer, MD; Iris Q. Grunwald, MD; Maria Politi, MD; Ludwig Gortner, MD; Wolfgang Reith, MD
Arch Neurol. 2009;66(7):906-907. doi:10.1001/archneurol.2009.99.
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A 4-month-old infant was referred to the pediatrics neurology clinic with macrocephaly. Her neurological status was normal. Sonography, magnetic resonance imaging (MRI) and angiography revealed a large vein of Galen aneurysmal malformation (VGAM) (Figure 1). The patient was treated endovascularly, using ethylene-vinyl alcohol copolymer (Onyx) as an embolic agent. Occlusion of the feeding arteries was complete, and there was no remaining flow into the VGAM (Figure 2). Follow-up MRI after 1 year showed that hydrocephalus persisted, whereas the VGAM had shrunk (Figure 2). The patient had development delay and seizures.

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Figure 2.

A, Postinterventional angiogram in frontal projection shows no remaining flow in the vein of Galen aneurysmal malformation (VGAM). Sagittal T2-weighted image 2 weeks after treatment shows no flow in the lesion. The VGAM appears hyperintense and homogenous hypointense in correspondence to building thrombus. B, Displacement of the brainstem and ventricles persists. T2-weighted magnetic resonance images 1 year after treatment show that the VGAM has shrunk. The borders of the aneurysm appear hypointense owing to collection of hemosiderin. The lesion no longer has a pressure effect. C and D, Note the subependymal atrophy.

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Figure 1.

A, Doppler sonography depicts 2 arterial feeders (arrows) and circular blood flow within the cyst, which demonstrates the vascular nature of the lesion. T2-weighted cranial magnetic resonance imaging in sagittal and transversal views show a vein of Galen aneurysmal malformation. B and C, Downward displacement of the brainstem and distortion of the ventricles with obstructive hydrocephalus. Digital subtraction angiography, frontal projection, and after-vertebral injection demonstrate a high-flow arterial feeder originating from the left posterior artery. The dome of the aneurysm is filled with contrast agent. D, Note the striking displacement of the arteries due to the lesion.

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