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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1813261
Case Report

Vein of Galen Malformation with Pial Arteriovenous Fistula in a 12-month-old Child

Autor*innen

  • Aman Bakhsh 

    1   Division of Multi-Disciplinary Research Unit, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India

  • Shubham Nema 

    1   Division of Multi-Disciplinary Research Unit, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India

  • Shubhendra Singh Tomar

    2   Department of Radiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India

  • Nishtha Yadav

    3   Department of Neuroradiology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
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Abstract

Pial arteriovenous fistulas are extremely rare vascular malformations of the brain (accounting for approximately 1.6% of vascular malformations of the brain) and are classified as Galenic and non-Galenic pial fistulas. We present a rare association of a mural-type vein of Galen malformation with a pial fistula involving the precentral branch of the right middle cerebral artery (MCA) in a 12-month-old infant. A 12-month-old preterm male infant, born vaginally with a delayed cry (birth weight 1.2 kg), presented with progressive macrocephaly, recurrent upper respiratory tract infections, developmental delay, and a history of seizures. Neurologically, the child was intact with no focal deficits. He was the firstborn child of a non-consanguineous marriage; maternal antenatal history was notable for polyhydramnios and fetal cardiomegaly detected on antenatal ultrasound. Antenatal scans at 26 and 28 weeks revealed aneurysmal dilation of the vein of Galen. Postnatal transfontanelle ultrasound showed enlarged lateral and third ventricles with a midline cystic lesion exhibiting turbulent flow, suggestive of a high-flow arteriovenous shunt. At 12 months of age, multidetector computed tomography (MDCT)) identified a 37 × 15 mm lobulated soft tissue density in the perimesencephalic/suprasellar region with ventriculomegaly. MRI of the brain confirmed a 35 × 19 × 21 mm flow void in the region of the vein of Galen associated with hydrocephalus, periventricular ooze, and cerebral atrophy. Digital subtraction angiography revealed a mural-type vein of Galen malformation fed by the right posterior choroidal artery, draining into the torcula. Additionally, a separate pial arteriovenous fistula was identified, supplied by the precentral branch of the right MCA, with cortical venous drainage into the superior sagittal sinus. Left sigmoid sinus hypoplasia with redirected venous outflow into the left superior petrosal sinus and cavernous system was noted. Mural-type vein of Galen malformation with concurrent pial arteriovenous fistula. The child was taken up for endovascular embolization. The vein of Galen malformation was embolized using 70% N N-butyl cyanoacrylate (NBCA). Subsequently, transarterial embolization of the right MCA pial fistula was done using coils and Onyx liquid embolic agent in the same sitting. Post-embolization, complete closure of both fistulas was noted. Post-treatment, CT revealed closure of fistulas with no fresh parenchymal abnormality. The child was discharged on postoperative day 6 without any focal deficit. At 3-month follow-up, the patient remained neurologically stable without new deficits, and follow-up MRI was planned.

Keywords

vein of Galen malformation - pial arteriovenous fistula - concurrent vascular malformations - mural-type VOGM - middle cerebral artery - endovascular embolization - infant cerebrovascular anomaly

Authors' Contributions

A.B. was involved in the conceptualization, manuscript writing, literature review, and imaging review. S.N. contributed through supervision, review of the manuscript, and assistance in manuscript drafting. S.S.T. was responsible for data collection, imaging interpretation, and assistance in manuscript drafting. N.Y. supervised the case, led the interventional procedure, and contributed to imaging interpretation, manuscript review, and editing. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.


Ethical Approval

This study was reviewed and approved by the Institutional Ethics Committee of Netaji Subhash Chandra Bose Medical College, Jabalpur, India. Written informed consent for publication of clinical details and images was obtained from the patient's legal guardian. All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the Declaration of Helsinki (2013 revision).


Patients' Consent

Written informed consent was obtained from the patient's legal guardian for publication of this case report and any accompanying images as per the institutional guidelines.




Publikationsverlauf

Artikel online veröffentlicht:
23. Dezember 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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