Staged transarterial embolization for vein of Galen aneurysmal malformation presenting in the neonatal period: a case report

Purpose: A neonatal case of vein of Galen aneurysmal malformation (VGAM) is described, and a review of published studies on pathophysiology and treatment of VGAM is presented. Case presentation: A male neonate presenting with heart failure was diagnosed as VGAM by MRI at postnatal day 6. Angiography performed at postnatal day 11 showed a choroidal-type VGAM, of which the largest afferent artery was embolized on the same day. Following the first session, a series of transarterial embolization sessions were performed at postnatal days 19, 61, and 138, resulting in a marked reduction of shunt flow. Although the patient showed catch-up growth after serial treatments, he underwent additional embolization for the residual shunt at the age of two years. Angiograms also indicated stenosis of the sigmoid sinus and normal venous drainage, dependent largely on collateral pathways. Conclusion: In treatment of VGAM, decisions about treatment modality and timing are critical. Also, careful observation is essential for detecting any subsequent change in cerebral blood flow dynamics.