Prenatal ultrasonographic diagnosis of vein of Galen aneurysms – report of two cases

Abstract

Aneurysms of the vein of Galen (AVG) represent less than 1% of all intracranial arteriovenous malformations. Two cases of prenatal diagnosis made by color Doppler ultrasonography at 32 weeks of gestation are reported. Both cases presented with antenatal mild cardiomegaly and both developed severe cardiac failure in the neonatal period. Embolization was unsuccessful and both infants died. These cases highlight the need for a careful evaluation of the time and mode of delivery; embolization must be performed after a fully informed decision.

Hidden mortality of prenatally diagnosed vein of Galen aneurysmal malformation: retrospective study and review of the literature

“…Like Rodesch et al . and others, we found that even relatively mild cardiac anomalies such as antenatal cardiomegaly were strongly associated with poor outcome.…”

Pseudofeeders on fetal magnetic resonance imaging predict outcome in vein of Galen malformations

“…12,17 Fetal cardiac assessment is currently difficult. In our experience, as in earlier articles, even when there is no evidence of severe heart failure in utero, fetuses with VGAM can develop significant cardiac impairment shortly after birth.…”

“…This rare congenital abnormality can cause severe morbidity and mortality-up to 100% in some reports on neonates with heart failure. [9][10][11][12][13][14][15] However, the prenatal natural history of VGAM and its complications is still unclear, and fetal echocardiography can be difficult to assess. Several prenatal findings are considered poor prognostic factors; these include evidence of heart failure (cardiomegaly and tricuspid insufficiency), polyhydramnios, pericardial and pleural effusion, edema and ascites, brain porencephaly, and ventriculomegaly.…”

Aneurysm of the Vein of Galen Diagnosed with MRI

“…Embolism is probably contraindicated when cardiomegaly or brain injury during labor is present [8]. Therefore, regarding complicated neonates with early development of severe heart dysfunction as in our case, vigorous respiratory and heart support in the Neonatal Intensive Care Unit is the first priority, keeping in mind that the prognosis is extremely poor [1]. …”

“…The aneurysm of the vein of Galen represents a rare intracranial arteriovenous malformation, accounting for 1% of all fetal arteriovenous vascular abnormalities [1]. Mainly correlated with the persistence of the embryonic median prosencephalic vein of Markowski [2], the dilatation of vein of Galen may have a severely detrimental impact on fetal or neonatal heart function, resulting in increased rates of neonatal morbidity and mortality [3].…”