PMC3173911_01
Contrast-enhanced MR images showing the vein of galen aneurysm in the midline causing compression of the third ventricle, leading to hydrocephalus
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F1
Computed tomography (CT) and magnetic resonance (MR) imaging [Figure 1] done at the time of presentation showed the VOGAM in the posterior interhemispheric fissure, causing a compression of the third ventricle and the cerebral aqueduct, leading to hydrocephalus.
Pre-embolization vertebral artery angiogram of the anteroposterior and lateral views (a,b), demonstrating the mural type of fistula (arrow), Post embolization vertebral artery angiogram (c,d) shows complete obliteration of the fistula with good visualization of the posterior cerebral artery (arrow)
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F2
Subsequently, an angiogram was done, which revealed a mural type of VOGAM [Figure 2a, b]. A post-procedure angiogram revealed complete occlusion of the fistula and better visualization of the PCA branches [Figure 2c, d].
PMC3173911_02
Digital substraction angiogram showing multiple feeders from the posterior choroidal arteries (arrows) in the choroidal type of VOGAM (a,b), with venous drainage into a large ectatic vein (c)
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F3
Numerous arterial feeders were seen from the bilateral posterior choroidal arteries [Figure 3a, b, c].
Vertebral angiogram demonstrating reduction in the flow to the malformation after the third session of embolization by NBCA (arrow) (a, b). Further reduction in the flow following the fifth session of embolization (c,d)
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F4
At the age of 18 months, a second session of embolization of the left posterior choroidal feeders was done using 33 and 25% NBCA resulting in 50% reduction in the flow [Figure 4a, b]. The child was taken up for the fifth session, and embolization of the residual feeders was done [Figure 4c, d].