CASE REPORT J Neurosurg Pediatr 19:729–733, 2017 T he vein of Galen aneurysmal malformation (VGAM) is a rare arteriovenous shunt that is es- timated to represent 30% of all pediatric vascular malformations. 8 It is a lesion supplied by the choroidal arteries through a fstulous connection with the median vein of the prosencephalon, the embryonic precursor of the vein of Galen. The venous anatomy seen in the VGAM is similar to that seen in the 12th gestational week of embryonic development, suggesting that the VGAM is a result of an error in vasculogenesis during this time period. The VGAM can be dichotomized into the mural type (one or more direct arteriovenous fstulas within the wall of the median vein of the prosencephalon) and the choroidal type (multiple arterial feeders creating a nidus- like structure that shunts into the dilated venous pouch). Clinical manifestations differ signifcantly depending on which angioarchitecture is present, with the mural type associated with less severe symptoms and an older age at presentation. 1 The most common causes of morbidity and mortality are high-output congestive heart failure (most common neonatal presentation), hydrocephalus (most common presentation in infants), headache, and seizures. Left un- treated, VGAM is associated with high rates of morbidity and mortality. 3 Over the last 3 decades, endovascular treat- ments have dramatically improved the prognosis. There is the potential for cure, and up to 74% of treated patients have normal neurological profles at long-term follow-up. 1 The techniques have evolved over time to include coils, N-butyl cyanoacrylate (TruFill; Codman Neuro) and eth- ylene vinyl alcohol copolymer (Onyx; Medtronic, Inc.). 3,12 The Micro Vascular Plug (MVP; Medtronic, Inc.) was re- cently introduced for arterial occlusion and has been used with promising results in neurovascular disease. 2,9,14 To ABBREVIATIONS MVP = Micro Vascular Plug; VGAM = vein of Galen aneurysmal malformation. SUBMITTED May 27, 2016. ACCEPTED December 8, 2016. INCLUDE WHEN CITING Published online March 24, 2017; DOI: 10.3171/2016.12.PEDS16305. Vein of Galen malformation treated with the Micro Vascular Plug system: case report Woojin Joo, BS, 1 Philippe Mercier, MD, PhD, 1 Shiva Kheradmand, BS, 2 Peyman Shirani, MD, 1 Ahmed Sarhan, MD, 1 Samer K. Elbabaa, MD, 1 and Randall C. Edgell, MD 1 1 St. Louis University School of Medicine, St. Louis, Missouri; and 2 Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona This case report describes the use of the Micro Vascular Plug (MVP) system in a mural-type vein of Galen aneurysmal malformation, resulting in successful occlusion of the cerebrovascular fstula. This result was confrmed with immediate cessation in blood fow and 6-month follow-up angiography. The unique characteristics of the MVP provide potential advantages over current embolic techniques for occlusion of high-fow, fstulous, intracranial vessels such as those seen in the vein of Galen aneurysmal malformation, and may represent a valuable addition to the currently available options. https://thejns.org/doi/abs/10.3171/2016.12.PEDS16305 KEY WORDS arteriovenous malformation; endovascular; Micro Vascular Plug; vein of Galen; vascular disorders ©AANS, 2017 J Neurosurg Pediatr Volume 19 • June 2017 729 Unauthenticated | Downloaded 05/07/22 08:53 AM UTC