Korean J Radiol.  2007 Apr;8(2):164-168. 10.3348/kjr.2007.8.2.164.

Transarterial Embolization with Berenstein Liquid Coils and N-butyl Cyanoacrylate in a Vein of Galen Aneurysmal Malformation: a Case Report

• Li MH
• Li WB
• Fang C
• Gao BL

• KMID: 1126840
• DOI: http://doi.org/10.3348/kjr.2007.8.2.164

Abstract

A 12-week-old baby with a vein of Galen aneurysmal malformation (VGAM) was successfully treated with performing transarterial microcatheter-directed embolization with Berenstein Liquid Coils and n-butyl cyanoacrylate in the feeding arteries. Post-procedure angiography showed a marked decrease of the blood flow into the dilated vein of Galen. Three months later, follow-up angiography showed that the vein of Galen aneurysmal malformation had totally disappeared, and the baby recovered very well without any sequelae. We report here on this interesting case along with a review of the relevant literature, and we aim to enhance physicians' awareness of the treatment for VGAMs.

Keyword

Aneurysm, cerebral; Interventional procedure; Interventional procedure, technology

MeSH Terms

Catheterization/*instrumentation
Cerebral Angiography
*Cerebral Veins
Cyanoacrylates/*administration & dosage
Embolization, Therapeutic/*instrumentation/methods
Humans
Infant
Intracranial Arteriovenous Malformations/diagnosis/*therapy
Magnetic Resonance Imaging
Male

Figure

• 

  Fig. 1 MR images (A. sagittal, T1-weighted image; B. axial, T2-weighted image) show a dilated vein of Galen with hydrocephalus.

• 

  Fig. 2 Angiography shows a vein of Galen aneurysmal malformation that is supplied from the bilateral posterior cerebral arteries and their branches (A. right internal carotid artery; B. left internal carotid artery; C. left vertebral artery).

• 

  Fig. 3 A. Plain film just after the injection of Berenstein Liquid Coils and n-butyl cyanoacrylate shows an inhomogenous distribution of radiopaque glue and free coils into the vein of Galen aneurysmal malformation. Angiography just after embolization (B. right internal carotid artery; C. left internal carotid artery) shows a marked decrease of flow into the vein of Galen aneurysmal malformation.

• 

  Fig. 4 Follow-up angiography three months after the procedure shows that the VGAM totally disappeared. (A. right internal carotid artery; B. left internal carotid artery; C. left vertebral artery)

• 

  Fig. 5 MR images taken three months after the procedure show the disappearance of the VGAM and the resolution of the hydrocephalus (A. sagittal, T1-weighted image; B. axial, T2-weighted image)

Reference

1. Johnston IH, Whittle IR, Besser M, Morgan MK. Vein of Galen malformation: diagnosis and management. Neurosurgery. 1987. 20:747–758.

2. Jones BV, Ball WS, Tomsick TA, Millard J, Crone KR. Vein of Galen aneurysmal malformation: diagnosis and treatment of 13 children with extended clinical follow-up. AJNR Am J Neuroradiol. 2002. 23:1717–1724.

3. Lasjaunias P, Garcia-Monaco R, Rodesch G, Ter Brugge K, Zerah M, Tardieu M, et al. Vein of Galen malformation. Endovascular management of 43 cases. Childs Nerv Syst. 1991. 7:360–336.

4. Dowd CF, Halbach VV, Barnwell SL, Higashida RT, Edwards MS, Hieshima GB. Transfemoral venous embolization of vein of Galen malformations. AJNR Am J Neuroradiol. 1990. 11:643–648.

5. Raybaud CA, Strother CM, Hald JK. Aneurysm of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation. Neuroradiology. 1989. 31:109–128.

6. Stanbridge Rde L, Westaby S, Smallhorn J, Taylor JF. Intracranial arteriovenous malformation with aneurysm of the vein of Galen as cause of heart failure in infancy. Echocardiographic diagnosis and results of treatment. Br Heart J. 1983. 49:157–162.

7. McElhinney DB, Halbach VV, Silverman NH, Dowd CF, Hanley FL. Congenital cardiac anomalies with vein of Galen malformations in infants. Arch Dis Child. 1998. 78:548–551.

8. 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.

9. Baenziger O, Martin E, Willi U, Fanconi S, Real F, Boltshauser E. Prenatal brain atrophy due to a giant vein of Galen malformation. Neuroradiology. 1993. 35:105–106.

10. Yang HJ, Choi YH. Posttraumatic pseudoaneurysm in scalp treated by direct puncture embolization using N-Butyl-2-cyanoacrylate: a case report. Korean J Radiol. 2005. 6:37–40.

11. Ha-Kawa SK, Kariya H, Murata T, Tanaka Y. Successful transcatheter embolotherapy with a new platinum microcoil: the Berenstein Liquid Coil. Cardiovasc Intervent Radiol. 1998. 21:297–299.