Arteriovenous malformation of the vein of Galen: treatment in a neonate
D. G. Watson, R. R. Smith and A. W. Brann Jr
Heart failure in a 2-day-old infant was not readily explained by clinical
examination. Cardiac catheterization suggested an intracranial
arteriovenous (AV) fistula, and cerebral arteriography showed a
malformation of the vein of Galen. The major feeding arteries were
surgically obliterated. At age 27 months, the boy has normal mentation but
moderate left hemiparesis. Review of the literature disclosed 39 other
infants with AV malformations of the vein of Galen producing heart failure
before age 3 months. Most of them were boys, and had cyanosis, a systolic
murmer, cranial bruit, cardiomegaly, and right bentricular hypertrophy.
Only three of the 13 who had surgery for their malformation survived.
Removal of the malformation is difficult; obliteration of the nutrient
vessels, using the operating microscope, is the currently accepted
treatment.
