Neurosurgery notes/Vascular/AV shunt/Vein of Galen disease/Vein of Galen Dilation

Vein of Galen Dilation

  • Dilation of the vein due to AV shunts from pial or meningeal arteries
  • Types:
    • Pial AVM with Vein of Galen aneurysm dilatation
      • Pial AVM in vein of Galen --> high flow of blood --> mechanical (turbulence causing thrombosis --> stenosis at jugular bulb and/or sigmoid sinus) or functional (high flow so blood can't leave as fast as it enters) Obs(x) --> dilation of the vein of Galen --> reflux of blood to normal cortical cerebral veins --> symptoms
      • Childhood or young adults
      • S&S
        • Intracerebral haemorrhage
        • Focal neurology (back flow of blood to normal veins causing venous ischaemia)
        • Seizure (same as above)
        • Cranial bruit: listen at eyeball and mastoid with stethoscope
        • High output failure or hydrodynamic changes
      • MRI/angiography: shows transmesencephalic feeders to diagnose
      • Tx:
        • Transarterial embolization onyx
        • DO NOT TRANVENOUSLY OCCLUDE VEIN OF GALEN--> can produce haemorrhage/venous infarct
    • Dural AVF with vein of Galen aneurysmal dilation
      • 40-50 yrs age
      • Shunts located at wall of Vein of Galen
      • Cortical reflux into cerebral veins
      • Feeders:
        • Dural falcotentorial arteries (ICA and ECA)
        • Vasa vasorum to the wall of the vein of Galen from pial arteries.
      • Presentation:
        • H/A (venous hypertension)
        • Seizure (? Cortical veins back pressure)
        • Cerebral haemorrhage
        • Cranial bruit: listen at eyeball and mastoid with stethoscope
        • Progressive cognitive dysfunction --> dementia (global cerebral ischaemia due to steal)
      • Tx: Transarterial embolization onyx