抄録
A case of aneurysm of vein of Galen in a 5½-month-old male baby is presented. The baby was born on February 16, 1978 and had apparently been well until age of 3 months, when he was suddenly seized with right hemiconvulsion. Positive findings on admission on Aug. 2, 1978 were setting-sun phenomenon, bulging of the anterior fontanel, equivocal weakness of the left lower limb, and bruit synchronous with pulsation on the scalp. The bruit was blowing, high-pitched and most prominent at the parieto-occipital region. CT scan disclosed an isodensity mass in the posterior part of the 3rd ventricle and symmetrical dilatation of the lateral ventricles. Cerebral angiography disclosed an enormously large aneurysm at the vein of Galen. Feeding arteries were the elongated and enlarged dural branch of the superior cerebellar artery on the right and bilateral medial posterior choroidal arteries. Draining veins were formed by huge straight sinus, basal vein, and dilated cortical veins.
A right ventriculo-peritoneal shunt was placed for obstructive hydrocephalus prior to direct approach to the aneurysm. On August 25 and September 14, 1978, left temporal craniotomies were done. The clippings and divisions of the feeding arteries to the vein of Galen aneurysm were performed via subtemporal approach. The aneurysm completely disappeared on the postoperative angiography and an avascular mass was present between both posterior cerebral arteries. On clipping of a major feeder during general anesthesia, systemic blood pressure and central venous pressure suddenly elevated and bradycardia developed and lasted for 45 minutes. After recovery from anesthesia, atrial fibrillation suddenly developed. Suitable digitalization and preserving the hypovolemic state were successful to make the regular heart rhythm return. Variability of heart rate continued for about 24 hours thereafter.
Postoperative CT scan and angiogram revealed bilateral subdural effusion. Repeated puncture and aspiration of the subdural fluid collection were performed but the fluid collection did not disappear. Postoperative PEG showed the patency of Sylvian aqueduct and no filling to the convexity subarachnoid space. Treatment of this subdural fluid collection still remains unsolved.
This case is the third surgical case of aneurysm of vein of Galen to appear in the Japanese literature.
