| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 3057843 | Interdisciplinary Neurosurgery | 2015 | 4 Pages |
•Rare case of a Yasargil Type IV-C secondary VGM related to a tectal AVM•Hydrocephalus can be managed effectively with an endoscopic approach.•Partial endovascular treatment of the lesion led to complete angiographic resolution.
Our goal is to describe a case of hydrocephalus in the setting of a Yasargil Type IV-C secondary vein of Galen malformation (VGM), treated with a combined endscopic and endovascular approach. We retrospectively reviewed the records of a patient admitted to the neurosurgical department hydrocephalus related to a secondary VGM.A 47 year old male, presents with 8 months of progressive headaches and gait ataxia. Imaging displays a triventricular hydrocephalus, a tectal AVM, and an aneurysmal dilation of the great vein of Galen. Angiography displays a tectal AVM supplied by bilateral posterior choroidals with drainage into the vein of Galen. In addition there were direct high-flow arteriovenous fistulas into the vein of Galen via meningeal feeders. The diagnosis of a Yasargil Type IV-C secondary VGM was made.The patient was treated via a combined endoscopic and endovascular approach. An endoscopic third ventriculostomy (ETV) was conducted for his hydrocephalus. He subsequently underwent a partial endovascular embolization of the left tentorial arterial feeder 1.5 months after his ETV.Post-operatively his hydrocephalus resolved, and his complex secondary VGM completely obliterated after a single partial embolization.Secondary VGMs with associated high-flow arteriovenous fistulas are rare. Our case provides a nice example a combined endoscopic and endovascular approach aimed at achieving cure of the hydrocephalus and the Yasargil Type IV-C secondary VGM. We were able to avoid the placement of shunt hardware via ETV treatment of the patient's hydrocephalus. Furthermore, our case displays the impact of partial embolization on control and potential cure of these complex vascular malformations.
