Radical surgery of a giant Galen's vein aneurysm using total circulatory arrest: case report

Arteriovenous malformations of Galen's vein are a rare type of vascular anomaly. The complex anatomy of these lesions creates an extremely difficult management dilemma. We report successful surgical treatment of a 7-year-old patient with a Galen's vein aneurysm.

A 7-year-old patient with slowly progressing gait disturbance, emotional instability, and strange behaviour is presented. A computed tomography scan revealed a high-density mass in the pineal region and cerebral angiography showed an aneurysm of Galen's vein. We decided to perform surgical excision of the aneurysm. The operation was performed under hypothermic circulatory arrest with barbiturate cerebral protection. The patient had no signs of postoperative ischemic deficits, hemorrhage, or neurologic deterioration.

Various techniques have been described for the obliteration of Galen's vein aneurysms, including direct surgical approach, staged operation, and transarterial, transvenous or transtorcular embolization. We present this patient to illustrate the use of hypothermic circulatory arrest and barbiturate cerebral protection for successful surgical excision of this complex vascular lesion. The combination of these techniques allowed us, in this case, to operate with reasonable safety on otherwise, difficult to treat aneurysm of Galen's vein.