8) Vein of Galen Malformation

Q: Is it an aneurysm or a malformation?

A: Malformation

favorite ABR topic/question

many cases on HSS

There are three types

Choroidal (fistula)

type present as neonates with high flow CHF

Mural (fistula)

the dilated VOG typically drains to a falcine sinus (median vein of the prosencephalon a la Lasjaunias)

(mural and choroidal types may be difficult to distinguish, unsporting to ask a resident to do this)

AVM (typically thalamic)

drains to VOG typically to a straight sinus

Q: Why do these patients get hydrocephalus

a. pressure on the cerebral aqueduct

b. venous hypertension (decreased CSF resorption)

A: b. venous hypertension (decreased CSF resorption)

topic comes up frequently at the Berenstein neurointerventional conference

Reference

http://www.medscape.com/viewarticle/545335_5

Dr. Berenstein (at RH collaborated with Dr. Lasjaunias, residents interested in neurointerventional should be aware or their 5 volume work Surgical Neuroangiography (see Dr. Lasjaunias’ eulogy in the lancet )(http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61577-9/fulltext)