Minim Invasive Neurosurg 2007; 50(5): 285-291
DOI: 10.1055/s-2007-990294
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Treatment of Hydrocephalus Due to Aneurysm of the Vein of Galen: Case Report and Literature Review

A. Feletti 1 , L. Denaro 2 , E. Marton 1 , D. d'Avella 2 , P. Longatti 1
  • 1Division of Neurosurgery, Treviso General Hospital, University of Padua, Treviso, Italy
  • 2Chair of Neurosurgery, Department of Neurosciences, University of Padua Medical School, Padova, Italy
Further Information

Publication History

Publication Date:
05 December 2007 (online)

Abstract

Aneurysms of the vein of Galen are uncommon vascular malformations. They are most frequently seen in infants and children, leading to heart failure and hydrocephalus. Exceptionally, they are detected in adults. Several theories have been proposed to explain hydrocephalus in these patients: obstruction of the cerebral aqueduct, impaired absorption of CSF after subarachnoid hemorrhage, passive ex-vacuo mechanism, or thrombosis of an aneurysm. Hydrocephalus has been treated mainly with cerebrospinal shunt procedures, but also direct surgery, radiosurgery and embolisation of the malformation have proved to be effective. We report the case of a partially thrombosed ectasia of the vein of Galen in a 44-year-old male, with huge hydrocephalus successfully treated with an endoscopic third ventriculostomy.

References

  • 1 Lasjaunias P, Ter Brugge K, Lopez Ibor L, Chiu M, Flodmark O, Chuang S, Goasguen J. The role of dural anomalies in vein of Galen aneurysms: report of six cases and review of the literature.  Am J Neuroradiol. 1987;  8 185-192
  • 2 Berenstein A, Lasjaunias P. Arteriovenous shunts involving the vein of Galen: endovascular treatment of cerebral lesions. Surgical Neuroangiography. Vol 4. Berlin, Heidelberg: Springer-Verlag 1992: 270-337
  • 3 Lasjaunias PL, Chang SM, Sachet M, Alvarez H, Rodesch G, Garcia-Monaco R. The management of vein of Galen aneurysmal malformations.  Neurosurgery. 2006;  59 ((Suppl)) S184-S194
  • 4 Matthews CJ, Klove H. Instruction Manual for the Adult Neuropsychology Test Battery Madison. University of Wisconsin Medical School 1964
  • 5 Stroop JR. Studies of interference in series verbal reactions.  J Exp Psychol. 1935;  18 643-662
  • 6 Rey A. L’examen psychologique dans les cas d’encephalopathie traumatique.  Archives de Psychologie. 1941;  28 21
  • 7 Raybaud CA, Strother CM, Hald JK. Aneurysms of the vein of Galen: embryonic and anatomical features relating to the pathogenesis of the malformation.  Neuroradiology. 1989;  31 109
  • 8 King WA, Wackym PA, Vinuela F, Peacock WJ. Management of vein of Galen aneurysms. Combined surgical and endovascular approach.  Childs Nerv Syst. 1989;  5 208-211
  • 9 Lasjaunias P, Hui F, Zerah M, Garcia-Monaco R, Malherbe V, Rodesch G, Tanaka A, Alvarez H. Cerebral arteriovenous malformations in children. Management of 179 consecutive cases and review of the literature.  Childs Nerv Syst. 1995;  11 66-79
  • 10 Lasjaunias PL, Rodesch G, Terbrugge K, Pruvost P, Devictor D, Comoy J, Landrieu P. Vein of Galen aneurysmal malformations. Report of 36 cases managed between 1982 and 1988.  Acta Neurochir (Wien). 1989;  99 26-37
  • 11 Lylyk P, Vinuela F, Dion JE, Duckwiler G, Guglielmi G, Peacock W, Martin N. Therapeutic alternatives for vein of Galen vascular malformations.  J Neurosurg. 1993;  78 438-445
  • 12 Valavanis A, Yasargil MG. The endovascular treatment of brain arteriovenous malformations.  Adv Tech Stand Neurosurg. 1998;  24 131-214
  • 13 Valavanis A, Wellauer J, Yasargil MG. The radiological diagnosis of cerebral venous angioma: cerebral angiography and computed tomography.  Neuroradiology. 1983;  24 193-199
  • 14 Yasargil MG. Microneurosurgery. Vol. III B. New York: Thieme Medical Publishers 1988: 323-357
  • 15 Yasargil MG, Antic J, Laciga R, Jam KK, Boone SC. Arteriovenous malformations of vein of Galen: microsurgical treatment.  Surg Neurol. 1976;  3 195-200
  • 16 Lazar ML, Clark K. Direct surgical management of masses in the region of the vein of Galen.  Surg Neurol. 1974;  2 17-21
  • 17 Thomson JL. Aneurysm of the vein of Galen.  Br J Radiol. 1959;  32 680-684
  • 18 Siqueira EB, Murray KJ. Calcified aneurysms of the vein of Gaier report of a presumed case and review of the literature.  Neurochirurgia (Stuttg). 1972;  15 106-112
  • 19 Beltramello A, Perini S, Mazza C. Spontaneously healed vein of Galen aneurysms.  Child Nerv Syst. 1991;  7 129-134
  • 20 Berlis A, Pechstein U, Schumacher M. Spontaneous closing of cerebral arteriovenous malformations by thrombosis of the nidus and the draining veins.  Röfo. 2002;  174 1318-1319 , [German]
  • 21 Gangemi M, Maiuri F, Donati PA, Laconetta G. Spontaneous thrombosis of aneurysm of the vein of Galen.  Acta Neurol. 1988;  10 113-118
  • 22 Hurst RW, Kagetsu NJ, Berenstein A. Angiographic findings in two cases of aneurysmal malformation of vein of Galen prior to spontaneous thrombosis: therapeutic implications.  AINR. 1992;  13 1446-1450
  • 23 Konovalov AN, Pitskhelauri DI, Arutiounov NV. Surgical treatment of the thrombosed vein of Galen aneurysm.  ActaNeurochir (Wien). 2002;  144 909-915
  • 24 Konus OL, Ilgit ET, Ozdemir A, Onal B. Spontaneous thrombosis of a vein of Galen aneurysmal malformation: possible effects of contrast media.  Eur Radiol. 2000;  10 1456-1458
  • 25 Nikas DC, Proctor MR, Scott RM. Spontaneous thrombosis of vein of Galen aneurysmal malformation.  Pediatr Neurosurg. 1999;  31 33-39
  • 26 Vijayaraghavan SB, Vijay S, Kala MR, Neha D. Prenatal diagnosis of thrombosed aneurysm of vein of Galen.  Ultrasound Obstet Gynecol. 2006;  27 81-83
  • 27 Whitaker JB, Latack JT, Venes JL. Spontaneous thrombosis of a vein of Galen aneurysm.  Am J Neuroradiol. 1987;  8 1134-1136
  • 28 Marques RM, Lobao CA, Sassaki VS, Aguiar LR. Vein of Galen aneurysm in an adult: case report.  Arq Neuropsiquiatr. 2006;  64 862-864
  • 29 Collins JJ, Fisher WS. Vein of Galen aneurysm presenting with recurrent aseptic meningitis and subsequent spontaneous thrombosis.  Surg Neurol. 1990;  33 325-328
  • 30 Tawk RG, Mohasseb G, Charbel Fl, Debrun GM. Spontaneous disappearance of vein of Galen malformation and posterior fossa venous pouch.  Acta Neurochir (Wien). 2002;  144 1225-1231
  • 31 Kuzeyli K, Cakir E, Karaarslan G, Ahmetoglu A, Peksoylu B, Yazar U, Baykal S. Spontaneous thrombosis of vein of Galen aneurysmal malformation after ventriculoperitoneal shunting.  J Clin Neurosci. 2004;  11 439-442
  • 32 Sasidharan CK, Anoop P, Vijayakumar M, Jayakrishnan MP, Reetha G, Sindhu TG. Spectrum of clinical presentations of vein of Galen aneurysm.  Indian J Pediatr. 2004;  71 459-463
  • 33 Grabowski EF, Head C, Michelson AD. Nonionic contrast media. Procoagulants or clotting innocents?.  Invest Radiol. 1993;  28 ((Suppl 5)) S21-24
  • 34 Hay KL, Bull BS. Factors influencing the activation of platelets by nonionic contrast medium.  J Vasc Interv Radiol. 1996;  7 401-407
  • 35 Karstoft J, Baath L. Vasodilatative and vasoconstrictive effects of angiography contrast media.  Acta Radiol Suppi. 1995;  399 164-169
  • 36 MacClennan BL, Stolberg HO. Intravascular contrast media. Ionic versus nonionic: current status.  Radiol Clin North Am. 1991;  29 437-454
  • 37 Brunefle F. Arteriovenous malformation of the vein of Galen in children.  Pediatr Radiol. 1997;  27 501-513
  • 38 Marques MC, Pires LA, Damasceno CA, Felicio AC, Atala A, Franco GM. Galen vein thrombosis: case report.  Arq Neuropsiquiatr. 2003;  61 285-287
  • 39 Krenz I, Power KJ. Postpartum thrombosis of the great vein of Galen.  Anaesthesia. 1990;  45 643-645
  • 40 Ildan F, Cetinaip E, Bagdatoglu H, Boyar B. Evolution of thrombosis of the vein of Galen in sickle cell disease.  J Child Neurol. 1993;  8 189-191
  • 41 Jamieson KG. Excision of pineal tumors.  J Neurosurg. 1971;  35 550-553
  • 42 Heinz ER, Schwartz JF, Sears RA. Thrombosis in the vein of Galen malformation.  Br J Radiol. 1968;  41 424-428
  • 43 Olin MS, Eltomey AA, Dunsmore RH, Roberts MP. Thrombosed vein of Galen aneurysm.  Neurosurgery. 1982;  10 258-262
  • 44 Weir BK, Allen PB, Miller JD. Excision of thrombosed vein of Galen aneurysm in an infant. Case report.  J Neurosurg. 1968;  29 619-622
  • 45 Copty M, Bedard F, Turcotte JF. Successful removal of an entirely calcified aneurysm of the vein of Galen.  Surg Neurol. 1980;  14 396-400
  • 46 Six EG, Cowley AR, Kelly Jr DL, Laster DW. Thrombosed aneurysm of the vein of Galen.  Neurosurgery. 1980;  7 274-278
  • 47 Carson LV, Brooks BS, el-Gammal T, Massey CE, Beveridge WD, Allen MB. Adult arteriovenous malformation of the vein of Galen: a case report with pre- and postoperative computed tomographic findings.  Neurosurgery. 1980;  7 495-498
  • 48 Dean DF. Management of clotted aneurysm of the vein of Galen.  Neurosurgery. 1981;  8 589-592
  • 49 Diebler C, Dulac O, Renier D, Ernest C, Lalande G. Aneurysms of the vein of Galen in infants aged 2 to 15 months. Diagnosis and natural evolution.  Neuroradiology. 1981;  21 185-197
  • 50 Skirkhoda A, Whaley RA, Boone SC, Scatliff JH, Schnapf D. Varied CT appearance of aneurysms of the vein of Galen in infancy.  Neuroradiology. 1981;  21 265-270
  • 51 Morais JV de, Lemos S. Calcified aneurysm of the vein of Galen - successful removal.  Surg Neurol. 1982;  17 304-306
  • 52 Di Rocco C, Tannelli A, Puca A, Colosimo Jr C. Spontaneous thrombosis of an aneurysm of the great vein of Galen.  Eur Neurol. 1983;  22 293-299
  • 53 Chapman S, Hockley AD. Calcification of an aneurysm of the vein of Galen.  Pediatr Radiol. 1989;  19 541-542
  • 54 Mancuso P, Chiaramonte I, Pero G, Tropea R, Guarnera F. A case of thrombosed aneurysm of the vein of Galen associated with superior sagittal sinus thrombosis.  J Neurosurg Sci. 1989;  33 305-309
  • 55 Hanigan WC, Brady T, Medlock M, Smith EB. Spontaneous regression of giant arteriovenous fistulae during the perinatal period. Case report.  J Neurosurg. 1990;  73 954-957
  • 56 Roszkowski M, Barszcz S, Grajkowska W, Kowalska A. Radical removal of a totally thrombosed vein of Galen aneurysm preoperatively diagnosed as a pineal neoplasm.  Neurol Neurochir Pol. 1993;  27 767-772 , [Polish]
  • 57 Kim BK, Ishii M, Oda N. Spontaneously thrombosed aneurysm of the vein of Galen: a case report.  No Shinkei Geka. 1996;  24 1139-1144 , [Japanese]
  • 58 Schulman H, Laufer L, Hertzanu Y. Complete calcification of an aneurysm of the vein of Galen.  Pediatr Radiol. 1998;  28 233
  • 59 Chiang V, Awad I, Berenstein A, Scott M, Spetzler R, Alexander MJ. Neonatal galenic arteriovenous malformation.  Neurosurgery. 1999;  44 847-854
  • 60 Mylonas C, Booth AE. Vein of Galen aneurysm presenting in middle age.  Br J Neurosurg. 1992;  6 491-494
  • 61 Mayberg MR, Zimmerman C. Vein of Galen aneurysm associated with dural AVM and straight sinus thrombosis. Case report.  J Neurosurg. 1988;  68 288-291
  • 62 Lewis AT, Tomsick TA, Tew Jr JM. Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery.  J Neurosurg. 1994;  81 851-859
  • 63 Pun KK, Yu YL, Huang CY, Woo E. Ventriculo-peritoneal shunting of acute hydrocephalus in vein of Galen malformation.  Clin Exp Neurol. 1987;  23 209-212
  • 64 O’Reilly GV, Hammerschlag SB, Ronthal M, Mullally WJ. Case report. Aneurysmal dilatation of the galenic venous system caused by a dural arteriovenous malformation.  J Comput Assist Tomogr. 1981;  5 899-903
  • 65 Rosenfeld JV, Fabinyi GC. Acute hydrocephalus in an elderly women with an aneurysm of the vein of Galen.  Neurosurgery. 1984;  15 852-854
  • 66 Askenazy HM, Herzberger EE, Wijsenbeek HS. Hydrocephalus with vascular malformations of the brain: a preliminary report.  Neurology. 1953;  3 213-220
  • 67 Agee OF, Musella R, Tweed CG. Aneurysm of the great vein of Galen. Report of two cases.  J Neurosurg. 1969;  31 346-351
  • 68 Hernesniemi J. Arteriovenous malformations of the vein of Galen: report of three microsurgically treated cases.  Surg Neurol. 1991;  36 465-469
  • 69 Kleindienst A, Hildebrandt G, Klug N, Schon R. Management of vein of Galen malformations. A review based on five neurosurgically treated cases and literature reports.  Zentralbl Neurochir. 1999;  60 172-182
  • 70 Abe T, Matsumoto K, Kiyota K, Tanaka H. Vein of Galen aneurysmal malformation in an adult: a case report.  Surg Neurol. 1996;  45 39-43
  • 71 Shin M, Kurita H, Tago M, Kirino T. Stereotactic radiosurgery for tentorial dural arteriovenous fistulae draining into the vein of Galen: report of two cases.  Neurosurgery. 2000;  46 730-733
  • 72 Ribeiro VT, Botelho LF, Lopes AC, Ribeiro P, Xavier JA, Teixeira JF, Cruz R. Choroidal type aneurysmal malformation of the vein of Galen associated with Dandy-Walker malformation in an adult.  Acta Med Port. 2003;  16 217-220 , [Portuguese]
  • 73 Amacher AL, Shillito Jr J. The syndromes and surgical treatment of aneurysms of the great vein of Galen.  J Neurosurg. 1973;  39 89-98
  • 74 Strowitzki M, Fox T, Hamann G. Transcranial color-coded sonography of a vein of Galen arteriovenous malformation in an adult.  J Neuroimaging. 2001;  11 205-208
  • 75 Tomsick TA, Ernst RJ, Tew JM, Brott TG, Breneman JC. Adult choroidal vein of Galen malformation.  Am J Neuroradiol. 1995;  16 861-865
  • 76 Wong KN, DeLuca J, Strax TE. Cognitive dysfunction following arteriovenous malformation of the vein of Galen: a case analysis.  Arch Phys Med Rehabil. 1996;  77 624-627
  • 77 Gibson JB, Taylor AR, Richardson AE. Congenital arteriovenous fistula with an aneurysm of the great cerebral vein and hydrocephalus treated surgically.  J Neurol Neurosurg Psychiatry. 1959;  22 224-228
  • 78 Zerah M, Garcia-Monaco R, Rodesch G, Terbrugge K, Tardieu M, Victor D de, Lasjaunias P. Hydrodynamics in vein of Galen malformations.  Childs Nerv Syst. 1992;  8 111-117
  • 79 Suh DC, Alvarez H, Bhattacharya JJ, Rodesch G, Lasjaunias PL. Intracranial haemorrhage within the first two years of life.  Acta Neurochir (Wien). 2001;  143 997-1004

Correspondence

E. Marton

Clinical Division of Neurosurgery

Treviso General Hospital

University of Padua

Piazza Ospedale 1

31100 Treviso

Italy

Phone: +39/0422/322 57 6

Fax: +39/0422/322 52 3

Email: emarton@libero.it

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