Midline giant arterio-venous malformations in infants

Three rare cases of giant midline arterio-venous malformations are presented. The first case is an infant girl with a vein of Galen malformation, who died from a subarachnoid haemorrhage a few weeks after shunt insertion for the control of hydrocephalus. The second case is an infant girl with a massive dilatation of the superior longitudinal sinus, who died from acute cardiac decompensation following direct surgery on the malformation. The third case is an infant boy with very large bilateral angiomas of the basal ganglia, who was not treated surgically. Some unusual features of these cases are discussed. Anatomically, the lesion can be quite different from a typical vein of Galen malformation. Clinically, the presence of cardiac failure and hydrocephalus is not always the case, and the possibility of a subarachnoid haemorrhage must be considered. For these reasons, infants with giant midline AVMs should be treated individually, balancing various considerations.