COMPLETE REMISSION OF VEIN OF GALEN ANEURYSMAL MALFORMATION: A CASE REPORT.

Introduction: Vein of Galen aneurysmal malformation (VGAM) has an incidence of 1% of all fetal arteriovenous vascular abnormalities. The first-choice method for the diagnosis is two-dimensional real-time ultrasound (US), and the Doppler mode confirming the vascular nature of the malformation. Two methods that are currently used for treatment are: endovascular transarterial embolization and direct surgical removal. The mortality remains around 50%. Case Report: A 24-year-old woman was referred to the Prenatal Diagnosis Unit of the Emergency University County Hospital of Craiova at 34 weeks and 5 days of gestation, with a suspicion of fetal cerebral vascular malformation. All clinical data and fetal US parameters were within normal limits, except for the presence of a hypoechogenic structure containing a turbulent arterial and venous flow. The structure was located in the midline of the posterior part of the third ventricle. The dilatation of the straight sinus was observed. Three-dimensional multiplanar images were instrumental in localizing the abnormal structure. A magnetic resonance imaging (MRI) exam was performed at 36 weeks, confirming the sonographic findings and no associated brain parenchyma abnormalities. Despite the isolated aspect of the malformation, the parents were informed about the poor postnatal outcome. At 37 weeks and 3 days a female neonate was delivered by cesarean section, with an Apgar score of 9 and weighing 2720 g. The transfontanellar US confirmed the diagnosis of VGAM. Mild cardiac complications and pulmonary hypertension were noted during the immediate postnatal period. At 3 months of age, a subsequent MRI revealed partial closure of the aneurysm and a normal ventricular system. At 32 months, an angio-MRI showed an entirely normal intracerebral vascular system. Currently, the child is completely asymptomatic at 5 years of age, having normal neurodevelopment. Discussions : The VGAM is characterized by the presence of numerous arteriovenous shunts linking the vein of Galen with the choroidal arteries. This pathology occurs more in male than female patients. The possible consequences of the pathology are the "vascular steal effect" and the overload of the right heart. Heart failure and cerebral damage are commonly seen. This congenital malformation has usually an ominous outcome. Conclusions: To our knowledge, this is the first documented case of spontaneous, complete remission of the VGAM, occurring at approximately 32 months post-birth. The single medical intervention was careful monitoring. [ABSTRACT FROM AUTHOR]