Multislice Spiral Computed Tomography in a Neonate with Vein of Galen Aneurysmal Malformation

Abstract

1 e C 2 G p 3 B V m d E F o a t 1-day-old male neonate developed dyspnea, tachycardia, allor, feeding difficulity, and jaundice. He was born at erm, with a 3.0 kg body weight, by vaginal delivery after n uncomplicated pregnancy. Prenatal diagnosis had not een done. He was noted to have heart murmur, cranial ruit, bounding pulse, and hepatomegaly. Transfontanellar ranial sonography showed vein of Galen aneurysmal malormation (VGAM). Arterial blood gas analysis revealed evere acidemia with pH 7.03 and base excess 19.8. omplications also included renal failure and disseminated ntravascular coagulopathy. The patient was treated with ntensive cardiopulmonary supports. We assessed theraeutic accommodation with a neonatal evaluation score, nd coil embolization for the VGAM was warranted. At ge 6 days, multislice spiral computed tomography MSCT) (Aquilion, Toshiba, Japan) was performed to valuate the architecture of cerebral vessels before coil mbolization. Contrast medium of 2 mL/kg was utilized. SCT showed VGAM with multiple feeders and drainers Figure 1; available at www.jpeds.com). At age 11 days and t age 19 days, transarterial coil embolization was perormed in the right and left cerebral feeders, respectively, s heart failure progressed (Figure 2). Although shunt flow as effectively decreased, the patient developed multiple rgan failure and unfortunately died at age 24 days. VGAM is a rare neurovascular malformation with xtremely poor morbidity and mortality. Recently, endoascular coil embolization has been established in the mangement of these patients. It is crucial to recognize the recise architecture of the VGAM before successful coil mbolization because the malformation is very compliated and chaotic. Although magnetic resonance angiogaphy before coil embolization is available, it takes longer ime to complete the image processing than MSCT. SCT is one of the useful imaging tools in the assessment f such a neonate with VGAM before endovascular interention.