Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 17 , ISSUE 4 ( October-December, 2023 ) > List of Articles


Vein of Galen Aneurysmal Malformations (VGAM): Prenatal Diagnosis

Snezana Crnogorac, Milutin Mitrović, Aleksandra Vuksanovic Bozaric

Keywords : Aneurysm, Case report, Galen vein, Prenatal diagnosis, Vascular malformation

Citation Information : Crnogorac S, Mitrović M, Bozaric AV. Vein of Galen Aneurysmal Malformations (VGAM): Prenatal Diagnosis. Donald School J Ultrasound Obstet Gynecol 2023; 17 (4):364-368.

DOI: 10.5005/jp-journals-10009-1990

License: CC BY-NC 4.0

Published Online: 28-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


The term, vein of Galen aneurysm, is related to a group of different vascular anomalies and may be defined as direct arteriovenous fistulas between choroidal and/or quadrigeminal arteries and an overlying single median venous sac. Data indicate that the venous sac most probably represents the persistence of the embryonic median prosencephalic vein of Markowski, not the vein of Galen. It represents a rear vascular anomaly, whose incidence is yet unknown, although some authors suggest numbers around 1:25000 deliveries. It accounts for only 1% of all intracranial malformations, but the percentage of this anomaly in pediatric populations is up to 30%. In most cases, the diagnosis is made postnatal, while antenatal diagnosis, because of the pathophysiology of the aneurysm itself, as well as the pathophysiology of its possible complications, is made usually during the third trimester. The earliest reported diagnosis was made at 25 weeks’ gestation. In the presence of vein Galen aneurysm malformations (VGAMs), high-output congestive heart failure with the development of fetal hydrops and hemispheric white matter injuries is a possible fatal outcome. They are associated with a poor outcome.

  1. Horowitz MB, Jungreis CA, Quisling RG, et al. Vein of Galen aneurysms: a review and current perspective. AJNR Am J Neuroradiol 1994;15(8):1486–1496. PMID: 7985568.
  2. Heling KS, Chaoui R, Bollmann R. Prenatal diagnosis of an aneurysm of the vein of Galen with three-dimensional color power angiography. Ultrasound Obstet Gynecol 2000;15(4):333–336. DOI: 10.1046/j.1469-0705.2000.00097.x
  3. Gerards FA, Engels MA, Barkhof F, et al. Prenatal diagnosis of aneurysms of the vein of Galen (vena magna cerebri) with conventional sonography, three-dimensional sonography, and magnetic resonance imaging: report of 2 cases. J Ultrasound Med 2003;22(12):1363–1368. DOI: 10.7863/jum.2003.22.12.1363
  4. Herghelegiu D, Ionescu CA, Pacu I, et al. Antenatal diagnosis and prognostic factors of aneurysmal malformation of the vein of Galen: a case report and literature review. Medicine (Baltimore) 2017;96(30):e7483. DOI: 10.1097/MD.0000000000007483
  5. Gupta AK, Varma DR. Vein of Galen malformations: review. Neurol India 2004;52(1):43–53. PMID: 15069238.
  6. Fayyaz A, Qureshi IA. Vein of Galen aneurysm: antenatal diagnosis: a case report. J Pak Med Assoc 2005;55(10):455–456. PMID: 16304858.
  7. Jerele C, Lovrič D, Kuhelj D. Pediatric interventional neuroradiology: opportunities and challenges. Children (Basel) 2023;10(4):715. DOI: 10.3390/children10040715
  8. Ballester MJ, Raga F, Serra-Serra V, et al. Early prenatal diagnosis of an ominous aneurysm of the vein of Galen by color Doppler ultrasound. Acta Obstet Gynecol Scand 1994;73(7):592–595. DOI: 10.3109/00016349409006280
  9. Ciricillo SF, Edwards MS, Schmidt KG, et al. Interventional neuroradiological management of vein of Galen malformations in the neonate. Neurosurgery 1990;27(1):22–27. DOI: 10.1097/00006123-199007000-00003
  10. Uddin MA, Haq TU, Rafique MZ. Cerebral venous system anatomy. J Pak Med Assoc 2006;56(11):516–519. PMID: 17183980.
  11. Raybaud CA, Strother CM, Hald JK. Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation. Neuroradiology 1989;31(2):109–128. DOI: 10.1007/BF00698838
  12. Doyle NM, Mastrobattista JM, Thapar MK, et al. Perinatal pseudocoarctation: echocardiographic findings in vein of Galen malformation. J Ultrasound Med 2005;24(1):93–98. DOI: 10.7863/jum.2005.24.1.93
  13. Yasargil MG. Microneurosurgery IIIB: AVM Of the brain, clinical considerations, general and special operative techniques, surgical results. 1988. pp. 405–438.
  14. Quisling RG, Mickle JP. Venous pressure measurements in vein of Galen aneurysms. AJNR Am J Neuroradiol 1989;10(2):411–417. PMID: 2494863.
  15. Alvarez H, Garcia Monaco R, Rodesch G, et al. Vein of Galen aneurysmal malformations. Neuroimaging Clin N Am 2007;17(2):189–206. DOI: 10.1016/j.nic.2007.02.005
  16. Sepulveda W, Platt CC, Fisk NM. Prenatal diagnosis of cerebral arteriovenous malformation using color Doppler ultrasonography: case report and review of the literature. Ultrasound Obstet Gynecol 1995;6(4):282–286. DOI: 10.1046/j.1469-0705.1995.06040282.x
  17. Li TG, Zhang YY, Nie F, et al. Diagnosis of foetal vein of galen aneurysmal malformation by ultrasound combined with magnetic resonance imaging: a case series. BMC Med Imag 2020;20(1):63. DOI: 10.1186/s12880-020-00463-6
  18. Pilu G, Falco P, Perolo A, et al. Differential diagnosis and outcome of fetal intracranial hypoechoic lesions: report of 21 cases. Ultrasound Obstet Gynecol 1997;9(4):229–236. DOI: 10.1046/j.1469-0705.1997.09040229.x
  19. Davel L, Smal J, Lockhat Z. MRI imaging of vein of Galen malformations at Steve Biko Academic Hospital: a mini case series. SA Journal of Radiology 2011;15(2):53–55. DOI: 10.4102/sajr.v15i2.328
  20. Frawley GP, Dargaville PA, Mitchell PJ, et al. Clinical course and medical management of neonates with severe cardiac failure related to vein of Galen malformation. Arch Dis Child Fetal Neonatal Ed 2002;87(2):F144–F149. DOI: 10.1136/fn.87.2.f144
  21. Yarden JA, Hauck LI, Athavale KV, et al. Tricuspid regurgitation and left ventricular eccentricity as a measure of heart failure in the newborn patient with a vein of Galen malformation: illustrative case. J Neurosurg Case Lessons 2022;4(15):CASE22323. DOI: 10.3171/CASE22323
  22. D'Amico A, Tinari S, D'Antonio F, et al. Outcome of fetal Vein Galen aneurysmal malformations: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022;35(25): 5312–5317. DOI: 10.1080/14767058.2021.1878494
  23. Lasjaunias PL, Chng SM, Sachet M, et al. The management of vein of Galen aneurysmal malformations. Neurosurgery 2006;59(5 Suppl 3):S184–S194. DOI: 10.1227/01.NEU.0000237445.39514.16
  24. Orbach DB, Wilkins-Haug LE, Benson CB, et al. Transuterine ultrasound-guided fetal embolization of vein of galen malformation, eliminating postnatal pathophysiology. stroke 2023;54(6):e231–e232. DOI: 10.1161/STROKEAHA.123.043421
  25. Karadeniz L, Coban A, Sencer S, et al. Vein of Galen aneurysmal malformation: prenatal diagnosis and early endovascular management. J Chin Med Assoc 2011;74(3):134–137. DOI: 10.1016/j.jcma.2011.01.029
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