Vein of Galen malformation

Question 1

VOGM or VOG anurysum , what is it and when develop .?

Answer 1

Congenital
Developer befor 3 month embryo stead

Question 2

Pathology or cause

Answer 2

medial vein of the prosencephalon

The vein of Galen is formed by the confluence of the internal cerebral veins ++ the basal vein of Rosenthal.

Question 3

🔺 AVM vs VOGM

Answer 3

VOGM retrograte filing of internal cerebral vein in the former.6

Question 4

VOGM feeding artery

Answer 4

medial and lateral choroidal, circumferential, mesencephalic, anterior choroidal, pericallosal, and meningeal arteries.

Agenesis of the straight sinus may be an associated finding.

Question 5

Presentation

Answer 5

CHF ❤️ ▶️ high flow
HC ▶️ compresse Sylvian aqueduct by enlarge VOg
Prominent scalp vein⏯️ high venous pressure

Question 6

Classification depend on the location

Answer 6

1. pure internal fistulae: single or multiple
2. fistulae between thalamoperforators and the VOG
3. mixed form: the most common
4. plexiform AVMs

Question 7

Outcome

Answer 7

Mortality 100% ⏩️ 1-12 m
Poor prognosis 😭

Question 8

YAŞARGIL classification

Answer 8

Type 3 MCC

Yasargil classification is probably the most descriptive one so far proposed, with application toward open neurosurgery

Type IVA: Pure plexiform nidus in the parenchyma of thalamus Type IVB: Pure plexiform nidus in the parenchyma of mesencephalon 5 Type IVC: Nidus within the parenchyma combined with fistulous cisternal nidus (type I)

Question 9

LASJEUNAS

Answer 9

Lasjaunias system is more applicable to endovascular approaches.
Choroidal type = Yasargil type I.( more complex and common CHF ♥️ )
Mural = Yasargil type 2 ➡️ Due to the smaller number of fistulas and more outflow obstruction, they are associated with more severe dilation of the median prosencephalic vein and manifest later in infancy as macrocephaly

Question 10

tX VOGM

Answer 10

Embolization ➡️ Trans-arterial embolization is the primary choice of treatment.

Mural 2 session
Choroidal multiple session

Question 11

BICERe score VOGM

Lasjaunias (Biceˆtre) score

Answer 11

Question 12

Embryology ➡️ median prosencephalic vein of Markowski usually regresses at

Answer 12

11th week of gestation, and by 3 months of gestation, the posterior part of it joins the internal cerebral veins and basal veins to form the vein of Galen.

Question 13

VOG 📍

Answer 13

quadrigeminal cistern.

Question 14

VOG drain

Answer 14

thalamus, the

medial temporal lobes, the occipital lobes, and the superior cerebellar

vermis.

Question 15

Classification

Answer 15

Question 16

Straight Sinus In VOG

Answer 16

Absent most of the time

Question 17

Melting brain syndrome

Answer 17

• fetuses, neonates, and infants, but it is not observed in adults.
  Due to ⬇️ CBF 🩸 and ⬆️ venous HTN ➡️ white matter destroy
  Associated with all AV fistula ex pial AVM and dural sinus

bilaterally

Question 18

Gold stander for diagnosis

Answer 18

DSA

Question 19

target sign. CT

Answer 19

central thrombus and peripheral circulating blood along the wall of the sac can produce the so-called “target sign.”

Question 20

Target sign 🪧

Answer 20

‘central thrombus and peripheral circulating blood along the wall of the sac can produce the so-called “target sign.”

Question 21

keyhole sign US 🔐

Answer 21

Prenatal ultrasonography shows the characteristic midline tubular anaechoic structure superior to the thalamus, which is contiguous with the dilated sagittal sinus (comet tail or keyhole sign).

Question 22

DDX of VOG

Answer 22

arachnoid cyst, cavum vergi, cavum septum pellucidum, and quadrigeminal cistern

Question 23

Embolization should be avoided for at least a few days after placement of a ventricular shunt t

Answer 23

avoid the risk for upward cerebellar herniation secondary to a rapid decrease in supratentorial pressure.

Question 24

Indication for tx

Answer 24

Unstable or progressive cardiac failure despite adequate medical treatment.

5 Chronic venous ischemia of the brain induces subcortical white matter

calcification.

Question 25

Microsurgery intervention Yasargil stage

Answer 25

Yasargil type I and less complex types II and III.

Question 26

How much contrast can tolerate

Answer 26

In most neonates, up to 8 mL/kg body weight of contrast material is well tolerated.

Question 27

Surgery for VOGM indication and approach

Answer 27

Yasargil 1 and mild 2-3

subtemporal, transcallosal, or transtentorial approaches.

The posterior interhemispheric approach is most commonly used to adequately access a vein of Galen malformation and expose the feeding arteries.

Question 28

of Galen Varix

Answer 28

VGV indicates dilation of the vein of Galen without the presence of an AV shunt and it is usually asymptomatic.
Two type
1➡️ transient asymptomatic dilation of the vein of Galen in neonates with cardiac failure from a cause other than VGAM. T
2 ➡️ as an anatomic variation in which venous drainage of the brain converges toward the deep venous system. It is also asymptomatic, but this arrangement of venous drainage may predispose to future venous thrombosis and resultant ischemic symptoms because of the lack of compliance.

Question 29

Trans arterial CI

Answer 29

occlusion of the venous dilation in the VGAD is contraindicated because it may produce hemorrhage or venous infarction of the deep cerebral structures as a result of occlusion of the outflow of these veins