Vein of Galen aneurysmal malformation: Strategy transarterial embolization using coils alone

Abstract

[1],[2],[3] A 15-month-old male child presented with seizures disorder, abnormally dilatation of the scalp and facial veins, and a mild increase in head circumference [Figure 1]a. Three-dimensional time-of-flight (3D TOF) magnetic resonance angiography (MRA) done at the age of 9 weeks revealed the VGAM [Figure 1]b. Three-dimensional computed tomographic angiography (3D CTA) at age 15 months demonstrated a mural-type VGAM with tortuous fistulas into the dilated draining MProsV of Markowski, and the embryonic falcine draining sinus was also visualized [Figure 1]c. Subsequent angiography showed two direct arteriovenous fistulas with high-flow communication supplied by posterior choroidal arteries originating from the left posterior cerebral artery [Figure 1]d. The lesion was embolized with multiple coils via transarterial approach two times at 15 and 18 months of age, respectively, which resulted in complete obliteration of the shunt without any complication [Figure 1]e. The child had an uneventful course. [4],[5] In neonates and infancy, clinical presentation is related to high-output congestive heart failure, hydrocephalus, and macrocephaly.