Management of vein of Galen aneurysms

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Abstract
Aneurysms of the great vein of Galen are rare and potentially lethal lesions, especially in early infancy. Sectioning of the feeding arteries and excision of the lesion were proposed for the best long-term results. An alternative approach was utilized in the 2 children discussed here. The computerized tomography (CT) scan established the precise diagnosis and demonstrated hydrocephalus and cortical atrophy preoperatively. Parieto-occipital craniotomy with an interhemispheric approach was performed to clip the numerous feeders. The procedure was terminated when the sac collapsed and blood aspirated from the lesion was venous in O2 saturation. A Doppler probe over the aneurysm then revealed a venous flow. Serial postoperative CT scans demonstrated that the mass had shrunk in size. Follow-up angiography was not thought necessary.