Abstract
A prenatally diagnosed aneurysm of the vein of Galen was presented in the fetus of a patient referred to our hospital at 32 weeks of gestation. Head MRI demonstrated bilateral ventricular dilatation, an aneurysm of the vein of Galen and hydrocephalus. A 3,132 g male was delivered by cesarean at 36 weeks of gestation. Although the patient presented with apnea, heart failure and hydrocephalus, we decided on emergency endovascular treatment according to Lasjaunias's neonatal evaluation score (9 points). Angiography showed a choroidal-type aneurysm of the vein of Galen. Transarterial embolization was performed on postnatal day 2, 6, 20, and 29, and transvenous embolization on postnatal day 29. The infant also underwent persistent arterial canal ligation against heart failure on postnatal day 26, and V-P shunting against hydrocephalus on postnatal day 22. Although the head CT revealed SAH after the 4th embolization, the size of the aneurysm was significantly reduced, and recovery from heart failure was also improved due to the reduction of shunt flow. On postnatal day 55, the infant died of progressive hepatic and renal failure. Although the transarterial embolization was useful to reduce the shunt flow and aneurysmal size, thorough treatment should have been provided in the early stage to prevent the eventually fatal multiple organic failure. We discuss the technique of multi-stage embolization and the treatment strategy for this difficult disease.
