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PubMed1980

Thrombosed aneurysm of the vein of Galen.

Computed tomography in a 3 1/2-year-old boy with ataxia, lethargy, fever, vomiting, and increasing irritability revealed moderate hydrocephalus and a blood density mass lesion lying superior and posterior to the 3rd ventricle. On several of the sections, the blood density was greater in the dependent than in the superior portion of the mass. The average attenuation number within the mass was 40 EMI units. The infusion of contrast agent demonstrated capsular enhancement (a target sign), which was also demonstrated by angiography. The diagnosis, which was confirmed at operation, was thrombosis of an aneurysm of the vein of Galen. The massive thrombus was resected, but the aneurysm was not excised. The patient's recovery was uneventful.

Cerebral Angiography↗
PubMed2004

The spinal cord and its roots according to Galen.

Galen's methodological approach to medicine anticipated modern rules. His experiments on the spinal cord contributed greatly to our knowledge of this structure by reporting the variegated pattern of neurological impairment after sectioning at different levels. His approach to injuries of the spinal roots and peripheral nerves documents both diagnostic skill and intellectual honesty.

Animals↗
PubMed2002

Prevalence of Galen's anastomosis: an anatomical and comparative study.

An anatomical study of 50 fresh adult human cadavers was performed in order to verify prevalence of Galen's anastomosis (GA) and to evaluate whether factors such as gender, ethnicity, side of the neck, and individual stature may interfere with GA prevalence. The results were analysed using the Chi-square test, Student t-test, and F-Snedecor test. GA was observed in 87 of 100 dissections. There was no statistically significant difference regarding GA prevalence between groups separated by ethnicity (p = 0.853), gender (p = 0.198), side of the neck (p = 0.766), or individual height (p = 0.199). Therefore, the GA was a frequent anatomical finding, and this result was not influenced by any studied factor. Comparing our data with previous studies, we also concluded that the GA seems to play an important role in the innervation of the larynx, even though its function remains unclear. Also, it is reasonable to consider GA a constant anatomical constituent.

Body Height↗
PubMed2003

[Galen vein thrombosis: case report].

Cerebral venous thrombosis (CVT) is a vascular disease with many clinical manifestations and possible etiologies (local, systemic or idiopathic). Galen vein thrombosis (GVT) is a rare cause of CVT and usually it is associated with some vascular malformation. We report a case of a 16 years old female patient with GVT without vascular malformation, but associated with straight sinus thrombosis and venous thalamic infarct. Relevant aspects of the clinical, radiological and laboratory diagnosis of CVT are also discussed.

Adolescent↗
PubMed1999

Galenic development and pharmacokinetic profile of indapamide sustained release 1.5 mg.

In accordance with international guidelines recommending the use of low doses of antihypertensive agents, a new formulation of indapamide--indapamide sustained release (SR)--has been developed. Indapamide has been used worldwide for many years as an immediate release (IR) formulation at a dose of 2.5 mg. The IR formulation leads to plasma peaks of indapamide immediately after administration of the tablet. These peaks are responsible for possible unfavourable electrolyte or metabolic effects relating to indapamide blood concentrations. The SR formulation, by eliminating plasma peaks, allows a smoothing of the pharmacokinetic profile of indapamide. This new galenic formulation is based on a hydrophilic matrix tablet composed of a cellulose derivative, methylhydroxypropylcellulose (MHPC), and a binder, polyvinylpyrrolidone (povidone). The originality of the matrix lies in the percentages of MHPC and povidone, which permit a linear release in vitro of indapamide. After optimisation, the chosen ratio of these 2 constituents allowed the release of more than 70% of the dosage over 16 hours in a very reproducible manner. The 2 tested formulations (SR and IR) have the same bioavailability; however, the main pharmacokinetic parameters of the new SR 1.5 mg formulation, calculated after single and repeated administration, show a profile typical of an SR formulation, i.e. a lower maximum concentration (Cmax), a longer time to Cmax, and the same minimum concentration as the IR formulation. This new SR formulation, which allows a reduction in the daily dose of indapamide from 2.5 to 1.5 mg, leads to an improvement in its efficacy/tolerability ratio, thereby meeting the recommendations of the international guidelines for the treatment of essential hypertension.

Biological Availability↗
PubMed2006

Twin-to-twin transfusion syndrome, vein of galen malformation, and transposition of the great arteries in a pair of monochorionic twins: coincidence or related association?

The pathogenetic mechanisms leading to the development of congenital heart disease and congenital intracranial arteriovenous malformation are still unclear. We report on a monochorionic twin pregnancy with twin-to-twin transfusion syndrome (TTTS), in which vein of Galen malformation (VGM) was diagnosed in the donor twin and transposition of the great arteries (TGA) in the recipient twin. The development of TTTS, VGM, and TGA in a single monochorionic pregnancy could be pure coincidence, but there might also be a causative link. We discuss the possible contribution of genetic factors, fetal flow fluctuations, vascular endothelial growth factors, and the process of twinning itself to the development of these congenital anomalies.

Abnormalities, Multiple↗
PubMed1994

Early prenatal diagnosis of an ominous aneurysm of the vein of Galen by color Doppler ultrasound.

A case of an aneurysm of the vein of Galen detected by color Doppler ultrasound (CDU) at 25 weeks of pregnancy is presented. The initial finding was a small defect of the posterior cerebral vein. Sonographic follow-up demonstrated an enlargement of the cerebral lesion as well as severe hemodynamic consequences. Fetal demise finally occurred at 28 weeks. Necropsy findings confirmed the diagnosis. This is the first report describing the value of CDU in the early diagnosis of such aneurysms.

Adult↗
PubMed1992

Vein of Galen aneurysm presenting in middle age.

A vein of Galen aneurysm occurring in a 55-year-old woman is presented. The pathogenesis and treatment of this condition, which is rare in adults, is discussed and the literature reviewed.

Cerebral Angiography↗
PubMed1981

Management of vein of Galen aneurysms. Report of two cases.

Aneurysms of the great vein of Galen are rare and potentially lethal lesions, especially in early infancy. Sectioning of the feeding arteries and excision of the lesions have been proposed for the best long-term results. An alternative approach was utilized in the two children discussed here. The computerized tomography (CT) scan established the precise diagnosis and demonstrated hydrocephalus and cortical atrophy preoperatively. Parieto-occipital craniotomy with an interhemispheric approach was performed to clip the numerous feeders. The procedure was terminated when the sac collapsed and blood aspirated from the lesion was venous in oxygen saturation. A Doppler probe over the aneurysm then revealed a venous flow. Serial postoperative CT scans demonstrated that the mass had shrunk in size. Follow-up angiography was not thought necessary.

Child, Preschool↗
PubMed1988

Vein of Galen aneurysm associated with dural AVM and straight sinus thrombosis. Case report.

A 64-year-old man presented with symptoms of obstructive hydrocephalus secondary to a vein of Galen aneurysm associated with a dural arteriovenous malformation and straight sinus thrombosis. The interrelationship of these lesions and their clinical and radiological features are discussed. It is proposed that in this case sinus thrombosis was the primary event in the subsequent development of the other lesions.

Arteriovenous Malformations↗
PubMed1998

Endovascular treatment of mural-type vein of Galen malformations.

OBJECT: In this study the authors report on the results of endovascular treatment for mural-type vein of Galen malformations (VGMs) in a group of infants. METHODS: Eight children (six infants and two neonates) who suffered from symptoms caused by a mural-type VGM were treated by means of endovascular therapy. Their age at the time of treatment ranged from 13 days to 19 months (mean 7.6 months). Two neonates and three infants who presented with hydrocephalus and increased head circumference, one of whom was stabilized with a shunt, underwent elective closure of the malformations 3, 4, 6, 6, and 13 months later, respectively. Two patients presented with hemorrhage; one had an intraventricular hemorrhage (IVH) on the 1st day of life and one, a 5-month-old infant, suffered a large parenchymal hemorrhage and an IVH; both patients were immediately cured by means of endovascular techniques. One child presented with a seizure and cortical venous drainage that were treated immediately. Eleven separate treatment sessions were conducted; eight via transarterial femoral access and the remaining three via a transvenous approach. Two patients were treated by using transfemoral transvenous embolization with fibered coils, and one patient required a transtorcular transvenous approach to permit complete closure of the fistula with electrolytically detachable coils. The embolic devices used included silk suture emboli (three patients), electrolytically detachable coils (three patients), and fibered platinum coils (seven patients). In seven patients, complete closure was demonstrated on postembolization arteriographic studies. The eighth patient had stagnant flow in a giant 6-cm varix treated with arterial and venous coils but has not yet undergone follow-up studies. Late follow-up arteriography was performed in four patients at times ranging from 11 to 24 months postprocedure. In one patient, thrombosis of the malformation and shrinkage of the varix were confirmed on follow-up computerized tomography scanning. The remaining three patients have not yet undergone follow-up angiographic examination. Two asymptomatic complications occurred, including separation of the distal catheter, which was removed with a snare device, and a single platinum coil that embolized to the lung, producing no symptoms in 101 months of clinical follow up. The follow-up period ranged from 3 to 105 months, with a mean of 52 months. CONCLUSIONS: Endovascular therapy is the treatment of choice for mural-type VGMs and offers a high rate of cure with low morbidity.

Arteriovenous Fistula↗
PubMed2000

Gamma surgery for vein of Galen malformations.

OBJECT: The goal of this study was to evaluate the results of gamma surgery in nine patients treated for vein of Galen malformations (VGMs). METHODS: A consecutive series of nine VGMs in eight children aged 4 to 14 years and in one adult were treated with gamma surgery. Six of the patients were male, including the adult, and three were female. Among these patients there were three Yasargil Type I, one Type II, two Type III, and three Type IV malformations. Previous embolization had failed in four cases. Three VGMs were treated with gamma surgery twice. An additional patient with a Type III VGM underwent stereotactic angiography in preparation for gamma surgery but was judged to be suitable for direct embolization. Follow-up angiograms were obtained in eight of the VGMs treated. Four no longer filled; one has probably been obliterated, but this cannot be confirmed because the patient refused to undergo final angiography; one patient has residual fistulas not included in the initial treatment field, which were retreated recently; and two other patients have marked reduction of flow through their VGMs. CONCLUSIONS: Gamma surgery is a viable option in the treatment of VGMs in clinically stable patients. Combined endovascular therapy and gamma surgery is of benefit in complex malformations.

Adolescent↗
PubMed2002

Galenic dural arteriovenous fistula: unusual clinical presentation and successful endovascular therapy. Case report.

The authors report a case in which the clinical and neuroimaging findings were initially considered diagnostic of a brainstem glioma. Angiography revealed a deep venous system (galenic) dural arteriovenous fistula causing brainstem interstitial edema. Successful endovascular surgery resulted in complete clinical recovery of the patient and resolution of the structural abnormalities that had been observed on magnetic resonance images. The neuroimaging and therapeutic significance of this case are discussed.

Central Nervous System Vascular Malformations↗
PubMed2003

Prenatal diagnosis of aneurysms of the vein of Galen (vena magna cerebri) with conventional sonography, three-dimensional sonography, and magnetic resonance imaging: report of 2 cases.

OBJECTIVE: To describe the cases of 2 fetuses with aneurysms of the vein of Galen diagnosed prenatally. METHODS: The techniques used were conventional sonography, three-dimensional sonography, and ultrafast magnetic resonance imaging. On the basis of these imaging modalities, prognostic factors, such as drainage and secondary damage, were assessed. RESULTS: The first fetus had good prognostic indices, and embolization after birth was successful. According to the prognostic factors, a poor neonatal outcome was predicted for the second fetus. The neonate died soon after birth. CONCLUSIONS: Conventional sonography, color Doppler imaging, and magnetic resonance imaging appeared to be useful diagnostic tools. The prognostic factors can be useful in counseling patients and providing the best possible care after birth.

Adult↗
PubMed1998

[Galen vein aneurysm. Review of the literature and report of 2 cases].

Aneurysm of the vein of Galen is a rare congenital disease, with a generally poor prognosis. It represents less than 1% of cerebral arteriovenous malformations. The intrauterine diagnosis of this vascular anomaly has been facilitated by vascular exploration with pulsed and color Doppler sonography. According to some studies focused on prognostical criteria, the perinatal prognosis seems to be invariably compromised when signs of cardiac decompensation develop prenatally, knowing that early delivery may generate additional complications in the very premature infant. Medical treatment is inefficient, because of the large, persisting systemic shunt, so that pregnancy termination may be performed, after parental consent, in some cases demonstrating all signs of cardiac decompensation. On the other hand, infants with normal velocity waveforms and a low extent of the systemic shunt have a good extrauterine adaptation. A full clinical evaluation of the affected neonates at the end of the first week of live is now the best way to select the infants for intravascular embolization.

Cerebral Veins↗
PubMed1997

From natural language to formal language: when MultiTALE meets GALEN.

In the GALEN project, the syntactic-semantic tagger MultiTALE is upgraded to extract knowledge from natural language surgical procedure expressions. In this paper, we describe the methodology applied and show that out of a randomly selected sample of such expressions, 81% could be analysed correctly. The problems encountered are summarised and areas of further investigation identified.

Humans↗
PubMed1999

Management of vein of Galen malformations. A review based on five neurosurgically treated cases and literature reports.

The high morbidity and mortality associated with the management of vein of Galen aneurysmal malformations (VGAM) continues to pose a tremendous challenge to the neurosurgeon as well as to the attending interventional radiologist. Since 1985, five patients with VGAM have been referred to the neurosurgical unit of the University of Cologne, two neonates, one infant and two adults. Four patients underwent direct operation and two patients received a shunt. The treatment was performed without mortality. A review of the literature reflects no substantial difference between neurosurgical treatment during the last 15 years (mortality 10%) and endovascular treatment (best series mortality 6%).

Adult↗