Todnem Nathan, Reddy Vamsi, Hayworth Miranda, Alleyne Cargill
Department of Neurosurgery, Augusta University, Augusta, Georgia, USA.
Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
World Neurosurg. 2018 Aug;116:296-298. doi: 10.1016/j.wneu.2018.05.184. Epub 2018 Jun 1.
Advances in endovascular embolization have improved morbidity and mortality among patients with vein of Galen malformations (VoGMs). The patient presented at 3 months of age with increased head circumference and a bruit over his anterior fontanelle. Diagnostic cerebral angiography confirmed the presence of a large mural-type VoGM. The decision was made to undergo a staged arterial embolization at 4 years of age after developing worsening right-sided hemiparesis. An attempt was made to occlude the posterior choroidal feeding vessel with a large 25 mm × 50 cm coil, followed by a 6 mm × 20 cm coil; however, the high flow of the lesion displaced both coils into the wall of the aneurysmal venous sac. Interval magnetic resonance imaging and angiography revealed partial occlusion of the VoGM at 7 months and complete thrombosis at 24 months post procedure, precluding a need for additional coiling. This case illustrates that a minimal change in intramural flow dynamics of VoGMs could lead to progressive thrombosis.
血管内栓塞技术的进步降低了大脑大静脉畸形（VoGMs）患者的发病率和死亡率。该患者3个月大时出现头围增大及前囟门处血管杂音。诊断性脑血管造影证实存在一个大型壁型VoGM。在出现右侧偏瘫加重后，决定在4岁时进行分期动脉栓塞。尝试用一个25 mm×50 cm的大线圈封堵脉络膜后供血血管，随后使用一个6 mm×20 cm的线圈；然而，病变处的高血流将两个线圈都冲入了动脉瘤样静脉囊壁。间隔期磁共振成像和血管造影显示，术后7个月VoGM部分闭塞，24个月时完全血栓形成，无需额外进行线圈栓塞。该病例表明，VoGM壁内血流动力学的微小变化可能导致进行性血栓形成。
