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Year : 2003  |  Volume : 13  |  Issue : 1  |  Page : 91-92
Antenatal diagnosis of vein of Galen aneurysm - case report


Department of Ultrasonography, Balku's Scan, PVS Hospital, Calicut 2, Kerala, 673002, India

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Keywords: Antenatal diagnosis, ultrasonography, vein of Galen aneurysm, vein of Galen malformation

How to cite this article:
Balakumar K. Antenatal diagnosis of vein of Galen aneurysm - case report. Indian J Radiol Imaging 2003;13:91-2

How to cite this URL:
Balakumar K. Antenatal diagnosis of vein of Galen aneurysm - case report. Indian J Radiol Imaging [serial online] 2003 [cited 2014 Jul 13];13:91-2. Available from: http://www.ijri.org/text.asp?2003/13/1/91/28636

   Introduction Top


Antenatal detection of intracranial cystic spaces demands color Doppler evaluation for a specific diagnosis. This case illustrates the ultrasonographic diagnostic features of vein of Galen aneurysm in a 32 weeks fetus with the help of color Doppler and power angio scans.


   Case report Top


A 27-year-old second gravida with normal obstetric history was referred for a routine scanning at 32 weeks of gestation. Her uterine size was corresponding to the period of amenorrhoea.

The ultrasound scan [Figure - 1] showed a normal fetus with average biometric values and normal volume of liquor. The gray scale image revealed a midline irregular anechoic space in the brain measuring 34 * 14 mm, lying posterosuperior to the third ventricle. Color Doppler [Figure - 2] and power angio [Figure - 3] scanning detected moderate turbulent flow in the cystic space with few feeder vessels merging at the periphery. A larger tubular vessel was seen toward the occipital region. These findings were diagnostic of vein of Galen aneurysm. The ventricles showed no dilation now. There were no signs of cardiomegaly or early hydrops. The other fetal morphological features were normal. Placenta had normal thickness and echo texture.


   Discussion Top


The unpaired great cerebral vein of Galen is formed by the fusion of two internal cerebral veins at the caudal part of the tela choroidea of the third ventricle. It passes caudally and dorsally to merge with the inferior sagittal sinus forming the straight sinus. An aneurysm involving the vein of Galen is a rare sporadic entity of unknown aetiology. Nearly 200 cases have been reported in the literature. The typical diagnostic features are of a midline irregular dilated vascular channel posterosuperior to the third ventricle and directed to the occipital region [1],[2],[3],[4]. Associated high-output cardiac failure is seen in 95% leading to hydrops. Hydrocephalus, subarachnoid or intraventricular hemorrhage may be seen in 5% [5]. Other sonographically detectable findings such as cardiomegaly, pericardial effusion, hepatosplenomegaly, ascites and polyhydramnios may also be evident. Ballantyne syndrome characterised by maternal edema, fetal edema and placentomegaly is rarely reported [6]. The usual differential diagnoses include arachnoid cyst, cavum vergi, cavum septum pellucidum and quadrigeminal cistern. None of these show flow on Doppler evaluation.

Serial scanning is indicated to monitor the development of obstructive hydrocephalus or hydrops since the prognosis depends on these.

 
   References Top

1.Vintzileos AM, Eisenfeld LI, Campbell WA et al. Prenatal ultrasonic diagnosis of arteriovenous malformation of the vein of Galen. Am J Perinatol 1986; 3:209-211.  Back to cited text no. 1    
2.Jeanty P, Kepple D, Roussis P et al. In utero detection of cardiac failure from an aneurysm of the vein of Galen. Am J Obstet Gynecol 1990; 163:50-51.  Back to cited text no. 2    
3.Dan U, Shalev E, Grief M et al. Prenatal diagnosis of fetal brain arteriovenous malformation: the use of color Doppler imaging. J Clin Ultrasound 1992; 20:149-151.  Back to cited text no. 3    
4.Lee TH, Shih JC, Peng SS et al. Prenatal depiction of angioarchitecture of an aneurysm of the vein of Galen with three-dimensional color power angiography. Ultrasound Obstet Gynecol 2000; 15 (4): 337-340.  Back to cited text no. 4    
5.Volpe JJ. Brain tumors and vein of Galen malformation. In: Neurology of the newborn: Neuronal Proliferation, Migration, Organisation and Myelination. 3rd ed. Philadelphia: WB Saunders, 1995: 802-806.  Back to cited text no. 5    
6.Ordorica SA, Marks F, Frieden FJ et al. Aneurysm of the vein of Galen: A new cause for Ballantyne syndrome. Am J Obstet Gynecol. 1990; 162:1166-1167.  Back to cited text no. 6    

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Correspondence Address:
K Balakumar
Balku's Scan, Railway Station Road, PVS Hospital, Calicut 2, Kerala, 673002
India
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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

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