Spontaneous Thrombosis of Vein of Galen Aneurysmal Malformation

Abstract

Two cases of aneurysmal malformations of the vein of Galen (AVG) with spontaneous thrombosis are reported. Angiogram and MRI before thrombosis demonstrated AVGs with slow arteriovenous shunts and associated stagnation of contrast in the venous sac secondary to severe outflow restriction. Based on these findings, one patient was managed conservatively, and the other underwent placement of a ventriculoperitoneal shunt. Surveillance of the lesions with subsequent MRIs revealed spontaneous thrombosis of the AVGs with excellent clinical outcomes. Proposed mechanisms of spontaneous thrombosis include slow flow shunts, obstruction of the venous outflow or obstruction of the feeding artery. Similar cases in the literature are reviewed with special emphasis on diagnostic tests, symptomatology, mechanisms of thrombosis and therapeutic options.

Vein of Galen malformation

“…4,23,26 Magnetic resonance imaging can identify the fistula location, presence of any nidus, venous drainage, venous thrombosis, and it can estimate the number and type of arterial feeders. 13,20,39 Importantly, because of its exquisite soft-tissue contrast, MR imaging is the modality of choice to evaluate the ventricular system and cerebral parenchymal damage, which is important for therapeutic decision making and prognosis. 4,13 Angiography.…”

Trombose da veia de Galeno: relato de caso

“…Alguns autores relatam que o número de casos de TVC é maior em mulheres e idosos 3,4 . Estudos mais recentes, entretanto, mostram que a TVC afeta igualmente ambos os sexos e todas as faixas etárias, com predominância discreta em adultos jovens 7 .…”

“…A maioria dos casos de TVG descritos na literatura está associada a malformação vascular, com incidência maior em neonatos e infantes [5][6][7] . Encontramos apenas um caso na literatura semelhante ao aqui relatado, em que a TVG não estava associada a malformação vascular 3 .…”

“…O padrão de apresentação e quadro clínico são extremamente variáveis e exames complementares de neuroimagem são essenciais para o diagnóstico [1][2][3][4] . A trombose da veia de Galeno (TVG) é causa rara de TVC e, na maioria das vezes, está associada a malformação vascular [5][6][7][8][9][10] .…”

Ultrasound Diagnosis of Congenital Brain Anomalies

“…If possible, method of treatment is emergency embolization or surgery. However, there are some reports of spontaneous thrombosis and calcification of aneurysm of the vein of Galen (Nikas et al, 1999;Chapman & Hockley, 1989).…”