Definition
- Dilation of the vein due to AV shunts from pial or meningeal arteries
Types
Pial AVM with Vein of Galen aneurysm dilatation
Numbers
- Childhood or young adults
Pathophysiology
- 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
Clinical features
- 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
Radiology
- MRI/angiography: Shows transmesencephalic feeders to diagnose
Management
- Transarterial embolization onyx
- DO NOT TRANVENOUSLY OCCLUDE VEIN OF GALEN → can produce haemorrhage/venous infarct
Dural AVF with vein of Galen aneurysmal dilation
Numbers
- 40-50 yrs age
Pathophysiology
- 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.
Clinical features
- 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)
Management
- Transarterial embolization onyx