Dr vera amarin, Dr hazem haboob

1. Successful endovascular treatment of aneurysmal malformation of Vein of Galen diagnosed prenatally by color Doppler ultrasound. Dr vera amarin, Dr hazemhaboob

2. Introduction • Vein of Galen malformation, also known as vein of Galen aneurysm is a rare congenital malformation of which only a few hundred cases have been published.

3. Introduction • These lesions are characterized by the presence of dilated midline deep venous structure, fed by abnormal arteriovenous communications.

4. Introduction • VOGA are believed to result from an insult to the cerebral vessels between 6 and 11 weeks of gestation.

5. Introduction The most sever cases present in the postnatal period with cardiopulmonary distress due to high-output cardiac failure resulting from arteriovenous shunts. Neonates with smaller communication may not have cardiovascular manifestations, but may later hydrocephalus.

6. Introduction Prenatal diagnosis of this vascular anomaly has been greatly help by the use of color Doppler U/S, which is important to differentiate this lesion from other cystic lesions of the fetal brain, because vein of Galen malformation is the only lesion that clearly displays blood flow within it.

7. Antenatal diagnosis has been associated with improved outcome • Recently, results have improved markedly with endovascular management.

8. We report a case of an aneurysm of the vein of Galen diagnosed at 38 week of gestation by ultrasound and color Doppler. and managed postnatal by endovascular procedure and team work.

9. Case Report MS M,R.25 years old PG. Referred to our feto maternal unit at KHMC from private clinic at 38 weeks gestation for further evaluation with a large cystic structure in the brain. On examination by ultrasound

17. A decision is made for delivery at 39 weeks’ gestation by elective C/S. • The diagnostic, prognostic and therapeutic problems were discussed with the parents by a team of obstetricians, neurosurgeons and pediatricians and interventional radiologist.

18. the mother underwent a cesarean section. a male infant weighing 3.600g with good Apgar score, no signs of congestive heart failure. • Postnatal MRI were performed which confirmed a big aneurysm of the vein of Galen,

21. Hydrocephalus was not present at birth. Echocardiography showed no heart malformations, with normal Doppler, • The child had no signs of cardiac decompensation, or liver enlargement. These findings and the absence of hydrocephalus allowed postponing of the surgical treatment.

22. The child’s clinical condition remained good, and his development was normal waiting for digital angiography and graded catheter embolization at one year.

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