Aneurysmal dilatation of the great vein of Galen occurs as a result of increased venous flow from an adjacent arteriovenous malformation. Excluding 15 reported aneurysms of less than 1.5 cm diameter, there are 47 previously reported instances of this condition (5, 12—14, 16, 20, 22, 24, 25, 27, 30). Eight patients showed an abnormality of cranial venous flow secondary to dural sinus occlusion (6, 9, 11, 12, 21, 26, 27, 31). The following case represents another report of such an association of vascular anomalies. Case Report L. S., an 11-year-old male, was referred to the plastic surgery unit of the University of Florida Teaching Hospital, Gainesville, Fla., for possible cosmetic repair of prominent superficial forehead veins. At one month of age, with no preceding infection or trauma, a soft, painless mass appeared at the glabella. The mass became more prominent with time, but never caused symptoms. At twenty months of age, the patient underwent bilateral carotid arteriography, accomplished without sequelae. An intracranial vascular malformation was diagnosed, and it was concluded that the associated facial lesion should not be surgically approached. At seven and a half years of age, repeat bilateral carotid arteriography disclosed substantially the same abnormalities as the earlier study. The family history was not significant. The patient acknowledged infrequent, mild, poorly localized headaches of brief duration. He denied hearing a bruit and had no symptoms suggestive of increased intracranial pressure. On examination at the University of Florida, the blood pressure was 110/60, and the pulse rate was 80 per minute. There was equivocal cardiomegaly, without murmurs, and the head circumference was in the fiftieth percentile for age. In the subcutaneous tissue about the eyes a soft, plexiform mass extended over the bridge of the nose onto the forehead and downward onto the medial cheeks (Fig. 1). The overlying skin had a slight violaceous hue. There was no associated ulceration. The mass was easily compressible, and a thrill was palpable at the medial border of the left eye; a continuous bruit with systolic accentuation could be heard over the area. A venous hum was audible over the calvarium more posteriorly. Funduscopic examination revealed venous engorgement and indistinctness of the disk margins; there were no hemorrhages or exudates. The remainder of the examination was normal. Skull roentgenograms showed bilateral enlargement of the superior orbital fissures (Fig. 2), no pathologic intracranial calcification, and no evidence of increased intracranial pressure. Later radiographs (Chamberlain-Townes, Law) demonstrated a vascular groove in the occiput housing the transverse sinus and sclerotic sinus plates demarcating the anterior extent of the sigmoid sinuses. On special jugular foramen views, the jugular canals were symmetrically diminutive, particularly in their lateral portions where the jugular bulb is normally housed.
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