Presentation
Child with increasing head circumference
Patient Data
Transfontanelle ultrasound showed a cystic lesion in the midline structure posterior to the third ventricle with severely dilated both lateral ventricles. In the Doppler examination image, there is a prominent, turbulent flow pulsatile cystic lesion which represents marked dilatation of a vessel in the region of the vein of Galen with connection to the straight sinus.
CT scan reveals a large homogeneous, well-defined round shape isodense mass lesion associated with dilated third and lateral ventricles and hydrocephalus because of the mass compression.
MRI sequences showed a well-defined midline round shape lesion hypointense in the T1 sequence, markedly T2 hypointense about (27 × 32 × 36 mm), hyperintense after contrast study, located posterior to the third ventricle which appears in continuity with a dilated inferior sagittal sinus. Also, moderate to severe hydrocephalous are noted.
Case Discussion
The vein of Galen aneurysmal malformation (VGAM) is a rare congenital arteriovenous deformity in the brain. There is aneurysmal enlargement of unpaired big cerebral vein (also called Vena Galeni) due to multiple shunts with brain arteries.
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