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NEUROIMAGES
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 1373-1374

Ectasia of transverse and sigmoid sinuses with vein of Galen malformation


Department of Neurosurgery, G. B. Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India

Date of Web Publication11-Nov-2016

Correspondence Address:
Dr. Pankaj Kumar
Department of Neurosurgery, G. B. Pant Institute of Postgraduate Education and Research (GIPMER), J.L.N. Marg, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.193791

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How to cite this article:
Kumar P, Rastogi V, Bodeliwala S, Kumar V, Singh H, Singh D. Ectasia of transverse and sigmoid sinuses with vein of Galen malformation. Neurol India 2016;64:1373-4

How to cite this URL:
Kumar P, Rastogi V, Bodeliwala S, Kumar V, Singh H, Singh D. Ectasia of transverse and sigmoid sinuses with vein of Galen malformation. Neurol India [serial online] 2016 [cited 2019 Nov 20];64:1373-4. Available from: http://www.neurologyindia.com/text.asp?2016/64/6/1373/193791


A 12-year-old female patient presented with weakness of left side of the body since birth, headache for 2 years, and right eye proptosis with progressive diminution of vision and pain in the eye for 3 months.

True vein of Galen malformations (VGAM) are arteriovenous fistulas (AVF), supplied by a variety of arterial feeding vessels that drain into the aberrantly persistent fetal median prosencephalic vein of Markowski,[1] an embryonic precursor of the vein of Galen which usually regresses during the 11th week of gestation. By the third month of gestation, its posterior part joins the internal cerebral veins and basal veins to form the vein of Galen. In a VGAM, the arterial tributaries to the median prosencephalic vein persist, along with the median prosencephalic vein itself. Failure of the normal degeneration of the median prosencephalic vein and persistence of its primitive arteriovenous fistulous connections are the central events leading to the persistence of this vein instead of the vein of Galen,[2] sometimes along with persistent fetal falcine vein, an accessory straight sinus or an accessory torcula [Figure 1] and [Figure 2].
Figure 1: Magnetic resonance angiography shows the dilated right internal carotid artery, right middle cerebral artery, external carotid artery, bilateral anterior cerebral artery, basilar artery and dilatation, and opacification of cortical and medullary venous channels. The transverse and sigmoid sinuses are hugely dilated along with dilated torcula, vein of Galen, superior sagittal sinus, internal cerebral vein, straight sinus, and superior ophthalmic vein extending into the cavernous sinus

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Figure 2: Digital subtraction angiography showing the dilated straight sinus and confluence of sinuses

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Therapeutic options available for a VGAM include open surgery, endovascular treatment, and stereotactic radiosurgery. The transarterial approach is preferred and is more effective in controlling the symptoms of VGAM.[1],[2],[3]

The reported case was diagnosed as Type I, choroidal type according to the Lasjaunias classification. It had multiple feeding arteries entering from anterior aspect of the median prosencephalic vein.[1]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lasjaunias PL, Chng SM, Sachet M, Alvarez H, Rodesch G, Garcia-Monaco R. The management of vein of Galen aneurysmal malformations. Neurosurgery 2006;59(Suppl 3):S184-94.  Back to cited text no. 1
    
2.
Mortazavi MM, Griessenauer CJ, Foreman P, Bavarsad Shahripour R, Shoja M, Rozzelle CJ, et al. Vein of Galen aneurysmal malformations: Critical analysis of the literature with proposal of a new classification system. J Neurosurg Pediatr 2013;12:293-306.  Back to cited text no. 2
    
3.
Gupta AK, Rao VR, Varma DR, Kapilamoorthy TR, Kesavadas C, Krishnamoorthy T, et al. Evaluation, management, and long-term follow up of vein of Galen malformations. J Neurosurg 2006;105:26-33.  Back to cited text no. 3
    


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