Great vein of Galen malformations in infancy1

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Four female infants with large cerebral great vein of Galen malformations were examined at the Cleveland Clinic between 1979 and 1982. All patients had a loud intracranial bruit and pulmonary flow murmurs with bounding peripheral pulses. Computed tomography (CT) scanning with contrast was diagnostic in all cases. A staged surgical procedure was performed in 3 of the 4 patients, and one patient died before surgery could be performed. Arterial feeders were clipped during two staged operative procedures with no surgical mortality. At follow-up 2 infants are developmentally normal. One infant, who had suffered preoperative intracerebral bleeding, continues to have evidence of hemiparesis and developmental delay. Awareness of the clinical signs of great vein of Galen malformations and rapid neurosurgical intervention with the use of a staged surgical approach may result in higher surgical survival rates than previously reported.



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