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Original research
Anatomy of the deep venous system in vein of Galen malformation and its changes after endovascular treatment depicted by magnetic resonance venography
  1. Olivia Winkler1,
  2. Waleed Brinjikji2,
  3. Heinrich Lanfermann1,
  4. Friedhelm Brassel3,
  5. Dan Meila1
  1. 1Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
  2. 2Department of Radiology and Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
  1. Correspondence to PD Dr. Dan Meila, Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover 30625, Germany; dmeila{at}yahoo.de

Abstract

Background and purpose It is classically thought that the internal cerebral veins (ICV) do not communicate with the venous pouch of vein of Galen malformations (VGM). We report on the anatomy of the deep venous system in VGM with special emphasis on the drainage of the ICV and possible changes after endovascular treatment.

Materials and methods We retrospectively analyzed DSA and 2D time-of-flight MR venograms of 55 children with VGM. We evaluated all pre- and post-operative images for the presence of the ICVs and determined their route of venous drainage.

Results Of 55 children, pre-operative 2D MRV detected the ICVs in 19 cases (35%) compared with one case (2%) for pre-embolization DSA (2%) (P<0.0001). Of the cases in which the ICVs were seen preoperatively, in 15 cases (78.9%) the ICV drained directly into the VGM while in the other four cases, the ICV used alternative venous drainage routes. On post-operative MRV, the ICVs were seen in 17 cases (31%) on MRV and 10 cases (18.2%) on DSA with drainage into an adult-like vein of Galen in 13 cases (76%), respectively (P=0.08). In four cases normal ICV drainage into the vein of Galen was seen even when the venous sac was closed. In two cases there was a change in ICV drainage from the vein of Galen to the lateral mesencephalic vein.

Conclusion The communication of the ICV with the VGM is a common phenomenon. Different changes of venous drainage routes do occur after treatment and are best seen on MRV.

  • magnetic resonance angiography
  • malformation
  • MRI
  • pediatrics
  • vein

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Footnotes

  • Contributors OW: acquired, analyzed, and interpreted data for the work; designed the study; drafted the manuscript and approved the final manuscript as submitted. WB: acquired, analyzed, and interpreted data for the work; drafted and revised the manuscript, and approved the final manuscript as submitted. HL: conceptualized the study, analyzed, and interpreted data for the work; critically revised the manuscript and approved the final manuscript as submitted. FB: conceptualized the study, analyzed, and interpreted data for the work; critically revised the manuscript and approved the final manuscript as submitted. DM: acquired, analyzed, and interpreted data for the work; designed the study; drafted the manuscript and approved the final manuscript as submitted. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval IRB approval was obtained from our local hospital’s Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors agree to share data on request.

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