Transvenous endovascular treatment for vein of Galen aneurysmal malformation with idiopathic bilateral sigmoid sinus occlusion.

Abstract

BACKGROUND Vein of Galen Malformations (VGAM) and bilateral idiopathic occlusion of the sigmoid sinuses are extremely rare. We report a child with Vein of Galen Aneurysmal Malformation (VGAM) and Idiopathic bilateral sigmoid sinus occlusion simultaneously, and managed through endovascular therapy in one session. This case highlights the coexistence of the lesions, as well as the one-session technical feasibility and good clinical outcome for endovascular treatment. CLINICAL PRESENTATION The child presented with enlarged head circumference and epilepsy. The frequency of seizure increased from one time to several times a day. CTA/CTV confirmed coexistence of Vein of Galen Malformations and idiopathic bilateral sigmoid sinus occlusion. CONCLUSION One session trans-venous approach was performed. The VGAM was completely occluded and the dominant sigmoid sinus was recanalized. Thirteen months telephone follow-up confirmed normal head growth. The patient is seizure-free and recovered very well with normal neurological and developmental condition. This study provides evidentiary support for one-session endovascular therapy in patient with VGAM and idiopathic bilateral sigmoid sinus occlusion.