Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

OBSTETRICS
Year
: 2003  |  Volume : 13  |  Issue : 1  |  Page : 91--92

Antenatal diagnosis of vein of Galen aneurysm - case report


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

Correspondence Address:
K Balakumar
Balku«SQ»s Scan, Railway Station Road, PVS Hospital, Calicut 2, Kerala, 673002
India




How to cite this article:
Balakumar K. Antenatal diagnosis of vein of Galen aneurysm - case report.Indian J Radiol Imaging 2003;13:91-92


How to cite this URL:
Balakumar K. Antenatal diagnosis of vein of Galen aneurysm - case report. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Apr 3 ];13:91-92
Available from: http://www.ijri.org/text.asp?2003/13/1/91/28636


Full Text

 Introduction



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



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



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

1Vintzileos 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.
2Jeanty 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.
3Dan 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.
4Lee 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.
5Volpe 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.
6Ordorica 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.