ANGIOGRAPHIC ANALYSIS AND RESULTS OF ENDOVASCULAR THERAPY OF ANEURYSMS OF VEIN OF GALEN

Angioarchitecture of the aneurysmal malformation of the vein of Galen in 9 patients is analysed. An arterial maze arborised directly into th e vein of Galen in 6 patients. Direct fistulous communication from one or two pedicles was noted in three children. Unilateral choroidal art erial contribution via an eccentric cul-de-sac in two infants suggeste d embryonic involvement of the ipsilateral internal cerebral vein alon g with the median prosencephalic vein of Markowski. Unusually, a sylvi an branch of the middle cerebral artery drained directly into the basa l vein of Rosenthal which in turn communicated to the aneurysm of vein of Galen in another patient. Two adult patients had curvilinear rim c alcification of the venous sac with rapid circulation. All but two sho wed venous sinus anomalies. Two children had prior shunt surgery at th e referring hospitals. The pathophysiology of hydrocephalus and the po ssible consequences of shunt, question the need for CSF diversion as a routine in these patients. Percutaneous trans-arterial embolotherapy, in five patients achieved complete obliteration of the malformation i n four patients and partial reduction of flow in another. While transv enous/trans-torcular approach is reserved for selected patients and di rect surgery carries high morbidity, this report emphasises the effica cy of trans-arterial embolotherapy.