Vein of Galen Aneurysmal Malformation: Patient Selection and Endovascular Management

Abstract

The literature has provided us with a large number of case reports and few series or reviews^1–6 of so-called arteriovenous malformations of the vein of Galen (AVMs of VG). All the cases regrouped presented with intracranial arteriovenous shunt (AVS) and an ectatic vein in the pineal region; however, the diseases involved were different and yet not differentiated. Clarisse¹ was among the first to suggest that true and false AVMs of VG could be distinguished, but still he included in the group of true malformations some cases that should have been excluded. In our earlier series⁵ of patients, we separated the lesions draining into the venous pouch with no reflux into the cerebral veins from those where reflux from the pouch into the usual tributaries of the Vein of Galen was noted (Fig. 7.1). We proposed to call the latter cerebral AVMs with vein of Galen ectasia, or vein of Galen aneurysmal dilatation (VGAD). The remaining group corresponds to vein of Galen aneurysmal malformations (VGAMs). The only common point of all these cases was the concept of venous obstacle, either inborn or acquired⁷ (Fig. 7.2).