VEIN OF GALEN MALFORMATION (VOGM)

Q1 What is VOGM?

VOGM is type of arteriovenous shunt which presents in infants. Here there is direct connection between brain arteries and vein of Galen. They are of two types: Mural and Choroidal

Q2 How child with VOGM presents?

Child with VOGM presents with:
1. Cardio-respiratory failure in neonatal period
2. Focal neurological deficit
3. Venous hypertension and raised intracranial pressure
4. Seizures

Q3 What are indications for treating VOGM?

All VOGMs should be treated.

Q4 How to treat VOGM?

Endovascular embolization is treatment of choice.

Q5 How VOGM embolization is done?

Step 1: Femoral artery is punctured and sheath is placed in femoral artery. VOGM is supplied by choroidal branch of anterior and posterior cerebral arteries.

Step 2: First guiding catheter (blue) is placed in carotid artery and microcatheter (yellow) is taken through guiding catheter in choroidal branch of anterior cerebral artery and it is embolized with glue.

Step 3: Then guiding catheter (blue) is placed in proximal vertebral artery and microcatheter (yellow) is taken through guiding catheter in choroidal branch of posterior cerebral artery and it is embolized with glue.

Step 4: Finally microcatheter, guiding catheter and sheath are removed.

CASE: 3months male child presented with complaints of excessive crying and not taking feeds. MRI shows VOGM