Anatomy of the deep venous system in vein of Galen malformation and its changes after endovascular treatment depicted by magnetic resonance venography

Olivia Winkler, Waleed Brinjikji, Heinrich Lanfermann, Friedhelm Brassel, Dan Meila

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)84-89
Number of pages6
JournalJournal of neurointerventional surgery
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2019

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Vein of Galen Malformations
Cerebral Veins
Phlebography
Anatomy
Magnetic Resonance Spectroscopy
Drainage
Therapeutics
Veins

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Anatomy of the deep venous system in vein of Galen malformation and its changes after endovascular treatment depicted by magnetic resonance venography. / Winkler, Olivia; Brinjikji, Waleed; Lanfermann, Heinrich; Brassel, Friedhelm; Meila, Dan.

In: Journal of neurointerventional surgery, Vol. 11, No. 1, 01.01.2019, p. 84-89.

Research output: Contribution to journalArticle

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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.",
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AB - 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.

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