Presentation
This infant presented at birth with high-output cardiac failure and multiple organ failure.
Patient Data
CT with contrast with three reconstructions: sagittal and axial maximum-intensity projection (MIP) and a 3D surface shaded reconstruction. These show an aneurysmal deep venous structure which drains to the vein of Galen, and then to an abnormal falcine sinus. The posterior part of the superior sagittal sinus is enlarged, as are the transverse and sigmoid sinuses. Feeding arteries are multiple, dilated and tortuous. They attach directly to the aneurysm without an intervening nidus.
Time of flight MRV - occiput is to the left, and skull vertex to the top of the image.
Case Discussion
This is a typical example of a vein of Galen malformation.
The patient was treated by endovascular occlusion of the larger feeding vessels. An intraprocedural arterial bleed was rapidly controlled. In the immediate postprocedural period the cardiovascular status improved. Ongoing high-output state will necessitate further procedures on a staged basis.
Case courtesy of Dr Lawghlin Dawes.
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