Vein of Galen Aneurysmal Malformations: An Overview for the Diagnostic Neuroradiologist

Vein of Galen aneurysmal malformations are rare direct arteriovenous fistulas between choroidal and/or quadrigeminal arteries and a midline venous pouch, which corresponds with persistence of the embryonic median prosencephalic vein of Markowski. We present an overview of the pathogenesis and angioarchitecture of these malformations. We also discuss their hydrovenous and hemodynamic complications, as well as the associated congenital and acquired vascular anomalies. A brief overview of their clinical presentation and treatment strategies is also presented. A better understanding of these rarely encountered vascular malformations, it is hoped, will facilitate interpretation of the frequently complex imaging studies of these patients.

Learning Objective: Understand the anatomy of vein of Galen malformations and identify their hydrovenous complications and associated congenital and acquired vascular anomalies.