Imaging Characteristics of Dural Arteriovenous Fistulas Involving the Vein of Galen: A Comprehensive Review.

Cureus. 2018 Feb 11;10(2):e2180. doi: 10.7759/cureus.2180.

Kassem MW, Choi PJ, Iwanaga J, Mortazavi MM, Tubbs RS.

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Abstract

Vein of Galen aneurysmal malformation (VGAM) is a rare angiopathy, which most commonly presents in infancy. Although very rare, it is associated with high morbidity and mortality rates. In order to minimize such morbid rates, a prompt diagnosis followed by a timely initiation of management is crucial. Multiple antenatal and postnatal imaging techniques for the diagnosis have been described and discussed in the literature. However, to our knowledge, a comprehensive review exploring such a list of imaging options for VGAM has never been established. We aim to review the diagnostic tools to aid in better understanding of the investigative modalities physicians may choose from when treating patients with a VGAM.

KEYWORDS:

aneurysmal malformation; arteriovenous fistula; diagnosis; imaging; prenatal; vein of galen

Figure 1

Schematic drawing of the pathomechanism of a vein of Galen aneurysmal malformation

Note the pericallosal artery and choroidal branches of the posterior cerebral artery (PCA) feeding the vein of Galen aneurysmal malformation (VGAM). Also note the prominent falcine sinus (FS) and the “accessory torcular” (AT).

SS: straight sinus; T: torcular.

Figure 2

Sagittal T1-weighted MRI of a child with a VGAM (red arrow)

Also note the enlarged torcular herophili (TH) (green arrow).

MRI: magnetic resonance imaging; VGAM: vein of Galen aneurysmal malformation.

Figure 3

MRI scout image noting the large VGAM (red arrow) seen in the patient shown in Figure ​Figure22

MRI: magnetic resonance imaging; VGAM: vein of Galen aneurysmal malformation.

Figure 4

Post-contrasted MRI of a patient with a large VGAM (red arrow) seen in Figures ​Figures22 and 3

MRI: magnetic resonance imaging; VGAM: vein of Galen aneurysmal malformation.

Figure 5

Axial T1-weighted MRI of the patient above with a large VGAM (red arrows)

MRI: magnetic resonance imaging; VGAM: vein of Galen aneurysmal malformation.

Figure 6

Coronal T2-weighted MRI of the patient above noting the large VGAM (red arrows)

MRI: magnetic resonance imaging; VGAM: vein of Galen aneurysmal malformation.

Figure 7

Angiogram, posterior view, noting the VGAM (red arrow), dilated TS (blue arrow), OOS variant (green arrow), and SS (yellow arrow)

VGAM: vein of Galen aneurysmal malformation; TS: transverse sinus; OOS: oblique occipital sinus; SS: sigmoid sinus.

Figure 8

Lateral skull radiograph noting a VGAM (red arrow)

VGAM - vein of Galen aneurysmal malformation