Radical surgery of a giant Galen's vein aneurysm using total circulatory arrest: Case report

BACKGROUND Arteriovenous malformations of Galen's vein are a rare type of vascular ano maly. The complex anatomy of these lesions creates an extremely difficult m anagement dilemma. We report successful surgical treatment of a 7-year-old patient with a Galen's vein aneurysm. METHODS AND RESULTS A 7-year-old patient with slowly progressing gait disturbance, emotional in stability; and strange behaviour is presented. A computed tomography scan r evealed a high-density mass in the pineal region and cerebral angiography s howed an aneurysm of Galen's vein. We decided to perform surgical excision of the aneurysm. The operation was performed under hypothermic circulatory arrest with barbiturate cerebral protection. The patient had no signs of po stoperative ischemic deficits, hemorrhage, or neurologic deterioration. CONCLUSIONS Various techniques have been described for the obliteration of Galen's vein aneurysms, including direct surgical approach, staged operation, and trans arterial, transvenous or transtorcular embolization. We present this patien t to illustrate the use of hypothermic circulatory arrest and barbiturate c erebral protection for successful surgical excision of this complex vascula r lesion. The combination of these techniques allowed us, in this case, to operate with reasonable safety on otherwise, difficult to treat aneurysm of Galen's vein. (C) 1999 by Elsevier Science inc.