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[Transarterial embolization of a vein of Galen aneurysm: a case report].

This report describes a case of a vein of Galen aneurysm. A 6-month-old baby with a slight head injury was referred to our hospital. CT scans and MR images demonstrated a vein of Galen aneurysm. Left carotid angiogram showed a vein of Galen aneurysm with a large feeding artery from the posterior cerebral artery. Transarterial embolization was performed using Galen coils and Interlocking Detachable Coils. Angiograms after the second embolization revealed complete occlusion of the aneurysm and postoperative course was uneventful.

Cerebral Angiography↗

Detection of an aneurysm of the vein of Galen following signs of cardiac overload in a 22-week old fetus.

OBJECTIVES: To present early prenatal diagnosis of an aneurysm of the Vein of Galen by detecting signs of cardiac overload in a 22-week old fetus. CASE: We report on a 22-week old fetus presenting with dilation of the heart, tricuspid and mitral valve regurgitation, reversed flow in the aortic arch and dilated neck vessels. Evaluation of the fetal brain revealed a dilated left ventricle, signs of brain hemorrhage and an anechoic structure between the two hemispheres. METHODS: By using the conventional Doppler technique, an intracerebral fistula and dilated vein of Galen was visualized. The complex vascular structure was demonstrated using 3-D color power angiography (3-D CPA). To our knowledge, this is the earliest diagnosis of this vascular malformation. CONCLUSION: Although signs of cardiac overload rarely appear before the third trimester in cases of arteriovenous fistulae, it was shown that these signs could lead to the correct diagnosis of an aneurysm of the vein of Galen. Additionally, we show that 3-D CPA is a promising technique to visualize complex vascular structures and make them easier to understand.

Abortion, Eugenic↗

Prenatal diagnosis of thrombosed aneurysm of vein of Galen.

Aneurysm of the vein of Galen in the fetus is a rare malformation that has been described in a small number of case reports. Thrombosis of aneurysm of the vein of Galen is a rare occurrence reported in postnatal cases. We report a case of thrombosis of vein of Galen aneurysm occurring in a fetus of 21 weeks' gestation. The fetus showed an echogenic mass posterior and superior to the thalamus. It also showed dilated dural venous sinuses, dilated neck vessels, cardiomegaly and minimal ascites. The pregnancy was terminated and autopsy confirmed the diagnosis. The present case is the first report of the prenatal sonographic features of this condition in the literature.

Adult↗

Management of vein of Galen aneurysms. Combined surgical and endovascular approach.

The extremely high morbidity and mortality associated with all forms of management of aneurysms of the vein of Galen continues to pose a tremendous challenge. Recent advances in neuroradiologic endovascular embolization techniques have offered some encouraging early results in the treatment of these vascular lesions. Our experience in managing two neonates and a 10-year-old boy with vein of Galen aneurysms is presented. The neonates underwent transtorcular embolization, while the boy was treated by standard transarterial balloon embolization. All patients had satisfactory outcomes. The combined surgical and radiologic approaches are simple when compared to previous surgical techniques, and early results suggest that they are preferable alternatives. The natural history of vein of Galen aneurysms and the various therapeutic modalities available are discussed.

Cerebral Angiography↗

Aneurysms of the vein of Galen in children: CT and angiographic correlations.

An aneurysm of the vein of Galen is a rare midline arteriovenous malformation. The clinical signs and the prognosis strictly depend on age of presentation and on the amount of blood shunted into the malformation. In the newborn, cardiac failure is the most common presenting sign. In order children hydrocephalus, headache, focal neurological signs and subarachnoid bleeding may be the reason for admission. At the Hospital for Sick Children six patients with an aneurysm of the vein of Galen were studied by angiography and CT. Four of them were newborn in cardiac failure. Angiography was essential for the accurate demonstration of all the feeding vessels to the malformation and their exact location. Computed tomography also added useful information on associated hydrocephalus and ischemic brain damage. The dilated vein of Galen, straight sinus and torcular were clearly seen. Abnormal arterial vessels feeding the malformation were also recognized.

Arteriovenous Malformations↗

Deep venous drainage in great cerebral vein (vein of Galen) absence and malformations.

We report two types of venous patterns associated with great cerebral vein (vein of Galen) absence or unavailability. Developmental venous anomalies or vein of Galen arteriovenous malformations (VGAM) serve as an illustrative material. A diencephalic pattern that collects the thalamo-striate veins into the tentorial sinus is recognized in most VGAM. A telencephalic arrangement connecting the striate veins with the rostral afferents to the basal vein is less frequent. Both patterns reproduce embryonic stages preceding the development of the great cerebral vein, thus confirming Raybaud's hypothesis that in VGAM the pouch is not the vein of Galen but the medial vein of the prosencephalon. The prognostic value of each pattern can then be appreciated and the therapeutic strategies rationalized; some unexplained complications of the venous approach for non selected VGAM can thus be avoided.

Arteriovenous Fistula↗

Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation.

Vein of Galen aneurysms may be defined as direct arteriovenous fistulas between choroidal and/or quadrigeminal arteries and an overlying single median venous sac. Anatomic analysis of 23 cases of vein of Galen aneurysm and correlation with known embryologic data indicate that the venous sac most probably represents persistence of the embryonic median prosencephalic vein of Markowski, not the vein of Galen, per se. The frequent concurrent venous abnormalities are easily understood as (a) retention of fetal anatomical features and (b) frequent occlusions of the dural sinuses of the posterior fossa, especially the sigmoid sinuses.

Adolescent↗

Arteriovenous malformation of the vein of Galen in three neonates: emphasis on associated early ischaemic brain damage.

UNLABELLED: Vein of Galen malformation is a rare intracranial disorder in newborns. In recent years the survival rate has improved due to improvement in endovascular treatment of this abnormality. We describe three neonates with a vein of Galen malformation for whom treatment was not attempted because of associated severe cerebral damage, of antenatal origin in two and of perinatal origin in the other. Autopsy was performed in two neonates. Periventricular leukomalacia was present in both cases, associated in one case with cortical infarction, gliosis and atrophy. CONCLUSION: We recommend careful evaluation of associated cerebral damage prior to attempted treatment of the vein of Galen malformation.

Atrophy↗

Spontaneous disappearance of vein of galen malformation and posterior fossa venous pouch.

Cerebrovascular anomalies remain an issue of controversy regarding diagnosis, classification, and treatment. We report the first case of total and asymptomatic regression and disappearance of a vein of Galen malformation associated with a posterior fossa venous pouch. Different aspects of the vein of Galen are discussed together with emphasis on the underlying mechanisms of spontaneous thrombosis and regression.A 4-month-old boy presented with macrocrania and signs of intracranial hypertension. Computerized tomography disclosed two masses, the first was a giant aneurysmal dilatation in the posterior fossa, and the second was a gigantic pouch at the level of the vein of Galen. Hydrocephalus was treated by ventriculo-peritoneal shunting. Two months later, the shunt was revised, and posterior fossa was explored without active treatment. Both abnormalities regressed spontaneously. No recurrence occurred, and the child remained neurologically intact. Total disappearance of the masses as well as normal brain and cerebrovascular anatomy were confirmed by angiography, MRI, and MRA. Over a follow-up period of 17 years, the patient did not develop complications. He had perfect clinical tolerance and resumed a normal life.

Cerebral Veins↗

Arteriovenous aneurysm of the vein of Galen. A clinical, angiographic CT scan and neuropathological study.

An autopsied case of arteriovenous aneurysm of the vein of Galen in a 31/2-month-old female is reported. Arteriovenous aneurysm of the vein of Galen is a rare vascular malformation of the central nervous system consisting of a saccular dilatation of the vein which receives blood shunted through enlarged arteries. These peculiar structural and hemodynamic characteristics differentiate this particular malformation from the other AVMs of the central nervous system. In infants the arteriovenous aneurysm of the vein of Galen is characterized clinically by hydrocephalus and cardiomegaly. In the present paper the clinical features and diagnostic indications are discussed and, in particular, the role of computerized cranial tomography (CT) is emphasized as a rapid and noninvasive procedure for detection of intracranial disorders.

Brain↗

Surgical obliteration for vein of Galen malformation: a case report.

BACKGROUND: Vein of Galen aneurysm is a relatively rare vascular malformation, often resulting in high morbidity or mortality. Outcome is particularly poor in the neonatal population. METHODS: We report staged surgical treatment of a vein of Galen aneurysm in a neonate who presented in congestive heart failure. RESULTS: Cerebral angiography 6 months following staged surgical treatment revealed complete obliteration of the aneurysm. The patient tolerated surgery well, and at 6 years of age is free of neurologic or cardiovascular impairment. CONCLUSIONS: While the endovascular approach is the procedure of first choice, aggressive medical management followed by staged surgical clipping of aneurysm feeders produced excellent results in this case of neonatal vein of Galen aneurysm. Staged surgical obliteration of arterial feeders should be considered as a therapy when endovascular methods are unsuccessful in safely curing these difficult vascular lesions.

Angiography, Digital Subtraction↗

Measurement uncertainty from validation and duplicate analysis results in HPLC analysis of multivitamin preparations and nutrients with different galenic forms.

An approach to calculate the measurement uncertainty in the HPLC analysis of several hydro- and liposoluble vitamins in multivitamin preparations with different galenic composition and properties is described. In the first instance it is examined if duplicate analysis results, obtained with a fully validated analysis method on different lots of an effervescent tablet preparation spread over several points of time, might contribute to calculate the measurement uncertainty of the HPLC method used and if the established uncertainty is acceptable in the assessment of compliance with the legal content limits. Analysis of variance (ANOVA) and precision calculations, based on the ISO 5725-2 norm are applied on the analysis results obtained to estimate precision components, necessary to derive the measurement uncertainty. In the second instance it is demonstrated to which extent the fully validated method of analysis for effervescent tablets is applicable to other galenic forms as e.g. capsules with oily emulsions, tablets, coated tablets, oral solutions, em leader and which specific modifications in the analysis steps are involved. By means of duplicate analysis results, acquired from a large series of real samples over a considerable period of time and classified according to their similarity in content, galenic forms and matrices, estimations of measurement uncertainty calculations are shown.

Chromatography, High Pressure Liquid↗

A contribution to the history of renal structure knowledge (from Galen to Malpighi).

This work documents the progressive gain in knowledge on renal anatomy acquired by anatomists from Galen to Malpighi. Galen, with albeit his rather imaginative explanations, was the first anatomist to recognize the urine producing function of the kidney. His influence was felt up to the Middle Ages; his followers imagined the presence of two cavities within the kidney that were separated by a porous membrane that they called the "colatorium" which was capable of filtering the urine from the blood. It was only later that Berengario da Carpi, divorcing himself from Galenic dogmatism, finally dismissed the presence of the colatorium. He described the renal papillae and gave the first elementary model of renal vascularization. Further important progress was due to the studies of Falloppius and Eustachius who brought contemporary understanding of renal structure to the limit of what could be seen with the unaided eye. They distinguished the difference between the unilobar canine kidney and the human multilobar organ, they also described the minor and major calyces and, furthermore, guessed at the canalicular structure of its parenchyma. Highmore was then responsible for the description of the archiform vessels which he hypothesized as an arterio-venous anastomotic net between the renal cortex and medulla. With the invention of the microscope, new doors opened for the study of renal structure. Bellini proved the canalicular organization of the parenchyma and, moreover, described the interlobular vessels. Malpighi then described the glomerulus and its relation to the intrarenal excretory ducts. The basis had now been laid for the beginning of modern nephrology.

Anatomy↗

Aristotle and Galen on sex difference and reproduction: a new approach to an ancient rivalry.

[I]n contrast to Aristotle's male oriented explanation of procreation the Galenic was 'feminist' inasmuch as both sexes were presented as contributing equally in conception and accordingly both had to experience pleasure... Anatomically, the two sexes were presented in Galenic accounts as complementary, the difference being that the man's genitalia were on the outside and the woman's on the inside. The clitoris was likened to the penis and the ovaries considered 'testicles' or 'stones' that produced seed. The male seed was, it is true, depicted by Galenists as superior in having 'spiritual' qualities lacking in the female, but Galen's reproductive schema was far more egalitarian than Aristotle's. (McLaren, 1985, p. 327)

Greece, Ancient↗

Exploiting the terminological approach from CEN/TC251 and GALEN to support semantic interoperability of healthcare record systems.

We apply the principles included in two CEN standards (ENV 12265, ENV 12264) to the analysis of the semantic structure of health record systems, to support their semantic interoperability. This result was made possible by dramatic methodological progress in the field of terminological systems--due to a worldwide evolution towards a new generation--and by the experience we acquired in the GALEN-IN-USE (formerly GALEN) project. The meaning behind names, content and context of record items and record item complexes can be considered as a 'semantic continuum'. This continuum is made explicit, by building a suitable paraphrase in a controlled language. We can then apply the principles we previously elaborated for the second generation of terminological system. Methodology and tools for generating a controlled language and a second-generation terminological system were developed and successfully used in the GALEN-IN-USE project and promising experiments were performed on elements of record structure listed in LOINC and SDM. In this way, the semantic structures of different record systems can be expressed by the resulting common formalism and thus, information units can be faithfully exchanged among different structures.

Italy↗

[Arteriovenous malformations of the vein of Galen].

Vein of Galen arteriovenous malformations encompass a diverse group of vascular anomalies that share a common feature: dilatation of the vein of Galen. Although clinical presentations are highly variable, depending on age of presentation, signs and symptoms overlap between age groups. The association of heart failure and cranial bruit constitutes the most striking clinical presentation in neonates. However, less severe and fulminant modes of presentation are frequent in older infants, children, and adults. Treatment approaches consist of symptomatic treatment of heart failure on the one hand and of surgery or endovascular treatment on the other. The results of the latter have improved in recent years, opening up a broad spectrum of new possibilities. We present the case of an asymptomatic 15-day-old neonate who presented an arteriovenous malformation of the vein of Galen and who was treated with endovascular occlusion of the arterial afferents. An excellent result was obtained with no evidence of neurological abnormalities.

Cerebral Veins↗

Prenatal depiction of angioarchitecture of an aneurysm of the vein of Galen with three-dimensional color power angiography.

A fetus with a large supratentorial cyst and cardiomegaly was encountered at 33 weeks of gestation. The cyst appeared as an aneurysmal, fluid-filled structure extending posteriorly with a finger-like appendage. Using color flow mapping, we disclosed rapid in-and-out blood flow with marked turbulence within the cyst. For evaluation of its blood supply and venous drainage of the vascular malformation, a three-dimensional reconstruction of the power Doppler image was conducted. The results revealed that the vascular malformation was supplied by a small contralateral aneurysm from the branches of Willis' circle, draining posteriorly into an abnormal falcine sinus and then into the superior sagittal sinus. No other fetal abnormality such as hydrocephalus or hydrops was discovered. The prenatal diagnosis of an aneurysm of the vein of Galen was made on the basis of the gray-scale, color Doppler findings, and also the angioarchitecture obtained by three-dimensional power Doppler imaging. The woman was admitted at 37 weeks of gestation due to labor onset and delivered the baby via the vaginal route without complication. Postnatal angiography and magnetic resonance imaging confirmed the diagnosis of an aneurysm of the vein of Galen, and the angioarchitecture depicted it before birth. We suggest that three-dimensional power Doppler ultrasonography may assist in the diagnosis of an aneurysm of the vein of Galen, and precisely delineate the complicated corresponding vasculature. This may guide postnatal management and predict the prognosis more accurately.

Adult↗

The Doppler-guided transfalcine venous approach in selected cases of vein of Galen malformations.

OBJECTIVE: This investigation was performed to evaluate the specific procedural issues and indications of a surgically assisted Doppler-guided endovascular transfalcine venous approach for the treatment of vein of Galen aneurysmal malformations (VGAM) in critically ill neonates. PATIENTS AND METHODS: Two neonates out of a clinical series of 15 children (8 males and 7 females) with vein of Galen malformations were treated by our neurovascular team, using a combined surgically assisted endovascular transfalcine approach. In the biplanar angiography room a radiographically guided craniotomy (1.5 cm) was placed over the cranial projection of the falciforme sinus. After craniotomy the orthograd flow of the falciforme sinus was identified by Doppler ultrasonography. The sinus was punctured by an i. v. cannula with injection port and was sutured to the skin. A microcatheter was maneuvered over a guide into the malformation under fluoroscopic control. For embolization Guglielmi electrolytically detachable platinum coils were placed into the malformation as an embolic agent. Neurological examination records, available MR images, computed tomographic scans, pre- and postembolization angiograms and follow-up data were analyzed. RESULTS: In both individuals the malformation was classified as VGAM. The follow-up was 6 and 7 months, respectively. No technique associated morbidity or mortality occurred in the present series. At discharge both selected neonates were in stable condition and the flow in the VGAMs could be significantly reduced by a combination of approaches including the venous transfalcine approach. Meanwhile, 6 months after birth one neonate died due to a deterioration of the pulmonary hypertension. CONCLUSIONS: Endovascular treatment is presently the most efficient strategy to allow neonates and infants survive the early manifestation of vein of Galen malformations and probably render a normal neurological development. Consequently, a combination of approaches in selected cases including the Doppler guided venous transfalcine route should be regarded as a preferential treatment modality, especially in patients with arterial vasospasms and venous stenosis.

Cerebral Angiography↗