Malformation of the great vein of Galen with neonatal heart failure. Report of two cases

History of surgery for cerebrovascular disease in children. Part II. Vein of Galen malformations

✓ Vein of Galen aneurysmal malformations are a mixed group of lesions characterized by an abnormal fistula between abnormal distal branches of the choroidal and/or posterior cerebral arteries and the great vein of Galen. In this paper the authors trace the historical evolution of the current approach to diagnosis and treatment, and the literature is reviewed comprehensively. During the historical era, vein of Galen malformations were described in individual case reports and an early classification system was developed. In the early era of treatment, open surgery was the preferred approach, although morbidity and mortality rates were high. The development of neurointerventional techniques allowed the introduction of occlusive materials into the fistula, with pronounced improvements in clinical outcome.

Congenital hepatic arteriovenous malformation: an unusual cause of neonatal persistent pulmonary hypertension

Congenital hepatic arteriovenous malformations are rare anomalies, which typically present in infancy with congestive heart failure, anemia, and hepatomegaly. Morbidity and mortality is high if the condition is not recognized and treated promptly. Hepatic arteriovenous malformation associated with persistent pulmonary hypertension of the newborn has been reported in two cases in the literature. We report a neonate who was referred for management of persistent pulmonary hypertension and was subsequently diagnosed with a large hepatic arteriovenous malformation. He underwent coil embolization following which pulmonary hypertension resolved.

Arteriovenous malformation of the vein of Galen: a rare cerebral arteriovenous malformation

A 32-year-old male presented to the emergency department for evaluation of a 12-day history of altered mental status. Workup revealed the presence of an arteriovenous malformation (AVM) of the great vein of Galen, an exceedingly rare and often fatal type of cerebral vascular malformation. Concurrent aneurysmic dilatation of the vein, a frequent finding associated with this type of AVM, resulted in compression of the aqueduct of Sylvius and acute hydrocephalus. A brief review of cerebral AVMs is presented, with specific attention to the pathophysiology, clinical presentation, and emergent treatment of those that involve the vein of Galen.

Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation

Vein of Galen aneurysms may be defined as direct arteriovenous fistulas between choroidal and/or quadrigeminal arteries and an overlying single median venous sac. Anatomic analysis of 23 cases of vein of Galen aneurysm and correlation with known embryologic data indicate that the venous sac most probably represents persistence of the embryonic median prosencephalic vein of Markowski, not the vein of Galen, per se. The frequent concurrent venous abnormalities are easily understood as (a) retention of fetal anatomical features and (b) frequent occlusions of the dural sinuses of the posterior fossa, especially the sigmoid sinuses.

Cerebral arteriovenous malformation in neonates. The role of myocardial ischemia

Ischemic myocardial damage was identified as a complicating feature in the clinical course of 12 newborn infants who died in congestive failure with cerebral arteriovenous malformation. Electrocardiograms of 11 patients showed signs of chamber hypertrophy and T wave and ST segment features of varying degree compatible with ischemia or infarction. Histological evidence of myocardial necrosis or infarction was detected in seven of the ten infants from whom autopsy material was still available.

Aneurysms of the vein of Galen. Experience at The Hospital for Sick Children, Toronto

✓ A study of the literature published between 1937 and 1981 revealed 128 aneurysms of the vein of Galen. Their clinical course and management are reviewed. During the years 1950 to 1980, 29 patients with an aneurysm of the vein of Galen were seen at The Hospital for Sick Children. In 14 of these patients surgical obliteration of their aneurysm was attempted, and in six this proved successful.

Anaesthetic management of arteriovenous malformations of the vein of Galen

Arteriovenous malformations of the vein of Galen, though rare, are associated with a significant mortality. The anaesthetic management of patients with this defect during surgery may be complicated by massive blood loss and congestive heart failure. Four patients under 18 months of age underwent craniotomies for arteriovenous malformations of the vein of Galen. Since two required a second craniotomy for ligation of residual feeding vessels, there were six procedures in the four patients. Average blood loss per procedure was estimated at 126 per cent of blood volume. One patient died during operation and one had an intra-operative cardiac arrest. Both of these patients had associated cardiac failure. In the presence of a compromised myocardium, sudden blood loss or attempts at induced hypotension may result in inadequate diastolic perfusion of the heart and precipitate cardiac arrest. Consequently, these patients should be maintained in a euvolaemic state with transfusion and attempts at controlled hypotension should be avoided.

Management of vein of Galen aneurysms. Report of two cases

Aneurysms of the great vein of Galen are rare and potentially lethal lesions, especially in early infancy. Sectioning of the feeding arteries and excision of the lesions have been proposed for the best long-term results. An alternative approach was utilized in the two children discussed here. The computerized tomography (CT) scan established the precise diagnosis and demonstrated hydrocephalus and cortical atrophy preoperatively. Parieto-occipital craniotomy with an interhemispheric approach was performed to clip the numerous feeders. The procedure was terminated when the sac collapsed and blood aspirated from the lesion was venous in oxygen saturation. A Doppler probe over the aneurysm then revealed a venous flow. Serial postoperative CT scans demonstrated that the mass had shrunk in size. Follow-up angiography was not thought necessary.

An arteriovenous malformation of the liver giving rise to persistent transitional (fetal) circulation

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