This case represents imaging features of choroidal type of vein of Galen malformation (VOGM) with extensive intracranial venous hypertension reflected by mild to moderate Hydrocephalic changes and bilateral optic nerve hydrops. Right cavernous sinus venous congestion is noted drained by dilated right superior petrosal sinus with secondary orbital venous congestion explaining clinical presentation of exophthalmos.

Choroidal type of VOGM  represents multiple feeders including thalamoperforating, choroidal and pericallosal arteries located in the subarachnoid space in the choroidal fissure. It usually presents in the neonatal period and progresses to high output cardiac failure.