Management of vein of Galen aneurysms. Combined surgical and endovascular approach.

The extremely high morbidity and mortality associated with all forms of management of aneurysms of the vein of Galen continues to pose a tremendous challenge. Recent advances in neuroradiologic endovascular embolization techniques have offered some encouraging early results in the treatment of these vascular lesions. Our experience in managing two neonates and a 10-year-old boy with vein of Galen aneurysms is presented. The neonates underwent transtorcular embolization, while the boy was treated by standard transarterial balloon embolization. All patients had satisfactory outcomes. The combined surgical and radiologic approaches are simple when compared to previous surgical techniques, and early results suggest that they are preferable alternatives. The natural history of vein of Galen aneurysms and the various therapeutic modalities available are discussed.