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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3644_Библиотеки_им_академика_М_И_Перельмана
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131Ve in of Galen Aneurysmal Malformation
Fig. 3.20A–C. Premature girl presented with cardiac failure immediately after birth.
Stabilization was obtained with medical treatment.At the age of 2 months,A MRI and
B, C angiography were performed because of the failure to thrive and abnormal neurological findings. A focal infarct was noted on MRI corresponding to arterial occlusive disease associated with VGAM.This neonatal moyamoya-like condition is a contraindication for treatment when noted, as it adds arterial depravation to venous
ischemic congestion
3Vein of Galen Aneurysmal Malformation132
Fig. 3.21A–D. Schematic representation of different types of deep venous drainage.
A Usual disposition, B epsilon aspect noted in VGAM, C medial parietal opening of
the internal cerebral vein, D associated transosseous drainage in the orbital region
(see Fig. 3.29). (Courtesy of J. Bhattacharya)
133Ve in of Galen Aneurysmal Malformation
Fig. 3.22A,B. Ty pi cal venous
pattern of the cerebral drainage
in a previously embolized
VGAM.Note the cortical anastomosis between the frontal
and sylvian veins and the
epsilon-shaped deep venous
system bilaterally. B Incomplete
capture of the sylvian vein on
the left side and A its almost
complete opening on the right
side. Note also the superior
and inferior petrosal sinuses
that are clearly demonstrated
on both sides
3Vein of Galen Aneurysmal Malformation134
Fig. 3.23A–C. Late venous phase of the carotid (A) and vertebral angiogram (B), 3D
angiographic aspect (C). Epsilon-shaped deep venous drainage into the superior petrosal sinus via the lateral mesencephalic vein
135Ve in of Galen Aneurysmal Malformation
Fig. 3.24A–C. Ty pical aspect of the epsilon-shaped venous return in a 13-year-old patient with a completely excluded VGAM. Note the bilateral drainage of the supratentorial collectors into the lateral mesencephalic vein and petrous vein infratentorially.
Occlusion of the right sigmoid sinus promoted the transcortical drainage into the
deep venous system
3Vein of Galen Aneurysmal Malformation136
Fig. 3.25. A VGAM with bilateral sigmoid sinus occlusion
secondary to jugular bulb
dysmaturation.All possible
supra- and infratentorial
anastomotic channels are
recruited to provide drainage.
Subependymal anastomoses
create a nidus-like network in
the vicinity of the VGAM itself.
B, C Oblique posterior and
superior 3D views of the venous
drainage
137Ve in of Galen Aneurysmal Malformation
Fig. 3.26A–E. A 12-month-old child presenting a VGAM
with already existing venous outlet restrictions and reflux
in sinuses and subependymal veins (A,B). C One year
after partial embolization, although the child was normal,
there was an increase in the pial reflux.D At short-term
follow-up, there was spontaneous occlusion of the falcine
outlets requiring rapid completion of the exclusion of
the remaining shunts (E)
3Vein of Galen Aneurysmal Malformation138
Fig. 3.27. A A 6-year-old boy with choroidal VGAM diagnosed 1 year before with
prominent facial veins and moderate macrocrania without neurological symptoms or
retardation. B On the MRI, note the stigmata and the chronic venous sinus congestion,which over time created subependymal anastomoses. C, D The angiographic
study demonstrates the subependymal inferior striate vein opening and its secondary
opening into the cavernous sinus
139Ve in of Galen Aneurysmal Malformation
Fig. 3.28A,B. VGAM with restricted outlet and transcranial opening in the subgaleal
veins
Fig. 3.29A–F. A 20-month-old boy presenting a supraorbital varix and a choroidal
VGAM (A,B). CBone X-rays suggested sinus pericranii confirmed on the venous phase
of carotid angiography with basal and lateral views on venous 3D angiography (D–F).
C–F see p. 140
3Vein of Galen Aneurysmal Malformation140
Fig. 3.29C–F. Legend see p.139
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