EP05.34: A twisted tale of vein of Galen malformation

Vein of Galen Aneurysmal Malformation (VGAM) is a rare congenital brain vascular abnormality characterised by the enlargement of the embryonic precursor of the vein of Galen - specifically, the median prosencephalic vein of Markowski. VGAM constitutes an arteriovenous fistula formed between the deep choroidal arteries and the embryonic median prosencephalic vein. Its development initiates early but is typically detectable via sonography only during the second or third trimester of gestation. The comprehensive assessment of the vascular anatomy of VGAM necessitates the examination of both afferent arterial feeders and efferent venous vessels. VGAM is usually diagnosed after 28 weeks gestation. Very few cases have been reported diagnosed in second trimester. Prognosis depends upon ampullary volume, dilatation of straight sinus and severity of tricuspid regurgitation. With the advent of endovascular neurointerventional techniques, the prospects for successful treatment are now much improved. Several treatment strategies have been advocated in the medical literature such as embolisation material (coils or glue), timing of treatment, and management of associated conditions such as hydrocephalus and congestive heart failure. We herein present our experience in diagnosing this rare condition at as early as 19 weeks. During routine anomaly scan, dilatation of superior vena cava was noted in three-vessel view and prompted us to see etiology which lead to VGAM finding. We had performed advanced neurosonogram with three-dimensional reconstruction of vascular structure of VGAM. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.