Rare basal vein fistula with dilated vein of Galen

Case report

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The authors present a rare case of arteriovenous fistula (AVF) of the basal vein of Rosenthal draining into a dilated vein of Galen managed by transarterial endovascular embolization. A male infant born at full term following a normal pregnancy and delivery with congestive heart failure, on investigation with MR imaging and MR angiography was found to have a basal vein of Rosenthal fistula with a dilated vein of Galen. His congestive heart failure was treated medically, and the AVF was managed electively at 10 months of age with successful transarterial endovascular embolization. The authors discuss the embryological aspects related to the pathological entity and the various clinical presentations, investigations, and management options. Management is primarily endovascular embolization; microsurgery is performed for a few selected cases, and radiosurgery has a limited role in older patients. Endovascular embolization is a safe and effective way to manage this malformation, with an excellent outcome if the AVF is eliminated by proper embolization at the fistulous point.

Abbreviations used in this paper:AVF = arteriovenous fistula; NBCA = N-butyl cyanoacrylate.

Article Information

Address correspondence to: Srinivasan Paramasivam, M.B.B.S., Hyman Newman Institute for Neurology and Neurosurgery, Centre for Endovascular Surgery, Roosevelt Hospital, 1000 Tenth Avenue, Suite 10 G, New York, New York 10019. email: kpsvasan@hotmail.com.

Please include this information when citing this paper: DOI: 10.3171/2011.12.PEDS11396.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial MR imaging studies of the brain showing the AVF of the basal vein draining into the dilated vein of Galen (A and B). The presence of an ipsilateral internal cerebral vein is seen in panel C.

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    Preembolization angiographic images of the AVF, the dilated vein of Galen, and the venous drainage showing the persistent falcine sinus and accessory falcine sinus.

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    Angiographic studies showing selective injections, anteroposterior and lateral views, at fistulous locations. A: Fistula 1. B: Fistula 2. C: Fistula 3. D: The native images showing the postembolization glue cast. Note how the fistulas enter from different directions into the same location.

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    Follow-up MR imaging studies (A and B) and angiograms (C and D) obtained 5 years after the procedure. The normalized vein of Galen is visualized on the MR imaging studies. The angiograms show no evidence of shunting of blood.

References

1

Chung JIWeon YC: Anatomic variations of the deep cerebral veins, tributaries of Basal vein of rosenthal: embryologic aspects of the regressed embryonic tentorial sinus. Interv Neuroradiol 11:1231302005

2

Lasjaunias Pter Brugge KGBerenstein A: Cerebral arteriovenous fistulas. Surgical Neuroangiography ed 2BerlinSpringer3:2006. 270289

3

Lasjaunias Pter Brugge KGBerenstein A: Vein of Galen aneurysmal malformation. Surgical Neuroangiography ed 2BerlinSpringer3:2006. 105226

4

Nelson PKNiimi YLasjaunias PBerenstein A: Endovascular embolization of congenital intracranial pial arteriovenous fistulas. Neuroimaging Clin N Am 2:3093171992

5

Ono MRhoton AL JrPeace DRodriguez RJ: Microsurgical anatomy of the deep venous system of the brain. Neurosurgery 15:6216571984

6

Padget DH: The cranial venous system in man in reference to development, adult configuration, and relation to the arteries. Am J Anat 98:3073551956

7

Suzuki YIkeda HShimadu MIkeda YMatsumoto K: Variations of the basal vein: identification using three-dimensional CT angiography. AJNR Am J Neuroradiol 22:6706762001

8

Tubbs RSLoukas MLouis RG JrShoja MMAskew CSPhantana-Angkool A: Surgical anatomy and landmarks for the basal vein of Rosenthal. J Neurosurg 106:9009022007

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