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

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)