Question

Discuss the clinico-radiological evaluation and treatment plan of a neonate born with an ante-natal diagnosis of Vein of Galen malformation.

Hint:

Early postnatal treatment of Vein of Galen malformation is essential to prevent long-term neurological impairment.

Answer 1

The diagnosis of Vein of Galen malformation (VGM) in a neonate is typically made through prenatal imaging, and it requires a multidisciplinary approach for management.
Step 1: Clinico-Radiological Evaluation:
1. Prenatal Diagnosis: VGM is often diagnosed through routine fetal ultrasound or MRI, which can identify the presence of hydrocephalus and abnormal blood flow in the cerebral veins.
2. Postnatal Imaging: Once born, the neonate should undergo a CT or MRI angiography to assess the extent of the malformation, including the number of feeding arteries and the size of the venous aneurysm. A cerebral angiogram is essential for detailed mapping of the vascular anatomy.
Step 2: Treatment Plan:
1. Initial Management: The neonate may require intensive care for stabilization, particularly to manage heart failure and hydrocephalus.
2. Endovascular Embolization: This is the most common treatment modality, where embolic agents are injected into the feeding arteries to close the fistula.
3. Surgical Resection: In cases where embolization is not feasible, surgical resection of the malformation may be considered.
4. Post-Treatment Care: Follow-up care includes monitoring for any neurological deficits and managing any complications such as seizures or cognitive delay.