C113 Saved by the clarinet: incidentally found vein of galen malformation on a 15-year-old

<h3>Introduction</h3> Vein of Galen aneurysmal malformations (VGAM) are rare congenital abnormalities due to the persistence of the median prosencephalic vein. Clinical manifestations can vary with the age of onset and vascular architecture. The wide spectrum of severity at presentation can be challenging to manage. <h3>Case Description</h3> We report the case of a 15-year-old male with a VGAM incidentally found on MRI for TMJ disfunction. The patient was an asymptomatic clarinet player and had no relevant clinical history. DSA revealed a choroidal/mural (Lasjaunias classification)/type III (Yasargil classification) VGAM with multiple arterial feeders from the right anterior and posterior choroidal arteries, and from the right anterior cerebral artery, to the median prosencephalic vein with venous drainage to cortical veins, superior longitudinal and lateral sinuses. Absence of both straight sinus and falcine sinus was noted. Due to the career as a clarinet player and frequent Valsava maneuvres, it was decided to treat the VGAM. Seven arterial pedicles were embolized, with significant flow reduction to the aneurysmal venous pouch. Eight weeks later, 4 other arterial pedicles were embolized and severe stasis inside the venous pouch was present. 6-month follow-up MRI/MRA revealed complete VGAM exclusion. <h3>Conclusions</h3> This case emphasizes the challenging management of VGAM in asymptomatic patients and rises awareness to VGAM as an incidental finding. <h3>Conflict of Interest</h3> No