In 1976 an infant boy initially presented with a choroidal vein of Galen malformation (cVOGM). Craniotomy and clipping of the anterior cerebral artery and posterior choroidal arteries was performed, which was reported in the literature 40 years ago. The patient remained asymptomatic until age 42 when he re-presented with an isolated intraventricular hemorrhage. Angiography demonstrated cVOGM with venous sinus occlusive disease leading to venous hypertension and subsequent intraventricular hemorrhage. The angiogram also demonstrated a ‘pseudo-nidus’ composed of multiple arterial-to-arterial anastomoses that had developed as a result of the original surgical treatment. We embolized a portion of the lesion to reduce the venous hypertension. The patient has been asymptomatic for more than 2 years. To our knowledge, this is the first reported case of a symptomatic neonatal VOGM treated with open surgery that required embolization as an adult for a delayed hemorrhagic presentation.
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Republished with permission from BMJ Case Reports Published 4 October 2016; doi:10.1136/bcr-2016-012709
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Contributors All authors of this work met ICMJE criteria for authorship and made substantial contributions to the conception and design, acquisition of data, analysis and interpretation of data, drafting, critical revising and final approval of this manuscript.
Competing interests LE has served as a consultant for Stryker Neurovascular, Microvention and Codman Neurovascular. LE has also served as a consultant for Sequent, Siemens, and received research support from Siemens. ASA has served as a consultant for Codman, Medtronic, Microvention, Penumbra, Sequent, Siemens and Stryker and has received research support from Siemens and Sequent.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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