PRENATAL SONOGRAPHIC DIAGNOSIS OF A VEIN OF GALEN ANEURYSM - RELEVANCE OF ASSOCIATED MALFORMATIONS FOR TIMING AND MODE OF DELIVERY

The term 'aneurysm of the vein of Galen' encompasses a range of differ ent midline arteriovenous fistula malformations. Prenatal real-time an d Doppler sonography can contribute to the differential diagnosis of f eral cerebral cystic lesions of various origins, pineal and choroid ru mors, and intracerebral hematoma. Regardless of the type of treatment, perinatal morbidity and mortality are high, often due to cardiac fail ure. A case of spontaneous delivery at 36 weeks of gestation by a 30-y ear-old woman presenting with a fetal aneurysm of the vein of Galen is described. As the extrauterine cardiac function was normal and a stea l phenomenon was not present, expectant management was justified. Five arterial embolizations within the following 4 years were performed as a means of treating the primary lesion. Our case illustrates the fact that elective spontaneous vaginal delivery followed by serial emboliz ation is possible in cases of arteriovenous fistula malformation witho ut signs of cardiac insufficiency.