Endoscopic third ventriculostomy for management of vein of Galen aneurysmal malformation-associated hydrocephalus with spontaneous thrombosis: case report

Vein of Galen aneurysmal malformations (VGAMs) are rare cerebrovascular anomalies due to lack of involution of the prosencephalic vein of Markowski in early gestation. Children born with such pathology may present with high-output cardiac failure, developmental delay, seizures, and hydrocephalus (Lasjaunias et al., 2006; Berenstein et al., 2010). Hydrocephalus may present due to aqueductal obstruction, intraventricular hemorrhage, or venous hypertension leading to absorptive deficit. Historical data suggests extremely high rates of complications associated with ventriculoperitoneal shunting when required in VGAM (Jea et al., 2010). Herein, we describe our experience with endoscopic third ventriculostomy for treatment of a partially embolized VGAM patient presenting with acute decline secondary to headaches, vomiting, and papilledema with evidence of symptomatic and radiographic resolution at two-month followup. Six-month MRI/MRA followup confirms persistent obliteration of the cerebrovascular lesion.