Aneurysms of the vein of Galen - problems in the diagnosis and treatment

Objective: The various clinical appearances of the vein of Galen aneurysms present considerable difficulties for diagnosis and treatment of the newborns having this vascular malformation. Objective was assess the clinical appearances, diagnostic procedures, therapeutic options and results in the cases having vein of Galen aneurysms. Material and methods: During the period 1990-2005 in the Department of Neurosurgery at the University Hospital "Alexandrovska" - Sofia, were treated seven children -5 (71.4 %) males and 2 (28.6 %) females, with diagnosed aneurisms of the vein of Galen. The age of the patients varied from 1 month to 12 years. Results: The internal hydrocephalus occurred in 6 (85.7 %) of the patients in our study. In three of them the signs and symptoms of progressive heart failure were also present. The onset of the disease was with Third Cranial Nerve palsy in one 12 years old patient. In the most of the cases the diagnosis was made soon after the birth. In one patient (14.3 %) the malformation was diagnosed prenatally by conventional ultrasound. Six of the children (85.7 %) were operated on. Five of them underwent open craniotomy clipping of the feeding vessels. The blood flow through the malformation was considerable reduced only in one of the patients operated using this approach. The sixth patient underwent ventricular punctures with reference to control of the excessive concomitant hydrocephalus. In this case the patient died. One patient was not operated on because of the presence of severe heart failure, bad general condition and neuroimaging data (computed tomography, and magnetic resonance imaging) for multiplicity of the intracranial vascular malformation. Discusion: The vein of Galen aneurysms are characterized with various clinical appearances, making their diagnosis difficult. Endovascular embolization is a method of choice for treatment in these cases.