case_images: PMC11079415_01
case_images: Digital subtraction angiography images: (a) Left vertebral artery run showing the posteromedial choroidal branch (arrow) of left posterior cerebral artery (PCA) feeding the vein of Galen aneurysmal malformation sac. (b) Endovascular selective cannulation of the posteromedial choroidal artery branches of the left PCA. (c) Onyx cast following the slow injection of concentrated onyx. (d) Immediate post-procedure angiogram showed marked slowing of flow within the dilated median vein.
case_images: SAJR-28-2841-g001.jpg
case_images: PMC11079415_01_SAJR-28-2841-g001.jpg
case_images: F0001
case_images: Cerebral digital subtraction angiography confirmed a mural type of VGAM (Lasjaunias classification) with feeders from both posterior cerebral arteries and the left anterior cerebral artery (Figure 1).
case_images: Follow-up MRI on day 3 post-procedure: (a) T1-fat-saturated post-contrast mid-sagittal, (b) T1-fat-saturated post-contrast axial, (c) Diffusion-weighted imaging axial at b 1000 s/mm2 and (d) Apparent diffusion coefficient axial at the same level as (c); showing the vein of Galen aneurysmal malformation thrombosed sac with hydrocephalus, mild peripheral rim enhancement and absence of restricted diffusion.
case_images: SAJR-28-2841-g002.jpg
case_images: PMC11079415_01_SAJR-28-2841-g002.jpg
case_images: F0002
case_images: Post embolisation MRI on day three revealed a minimal reduction in the size of the VOG sac, with minimal enhancement of the sac wall and no internal restricted diffusion, as shown in Figure 2.
case_images: Follow-up MRI at 1-month post-procedure demonstrating the chemical abscess: (a) T1FS post-contrast mid-sagittal, (b) T1-fat-saturated post-contrast axial, (c) Diffusion-weighted imaging axial at b 1000 s/mm2 and (d) Apparent diffusion coefficient axial at the same level as 3c; showing a mild reduction in the size of the aneurysmal sac, persistent hydrocephalus, thick peripheral mural enhancement and marked restricted diffusion.
case_images: SAJR-28-2841-g003.jpg
case_images: PMC11079415_01_SAJR-28-2841-g003.jpg
case_images: F0003
case_images: Follow-up MRI after 1 month revealed a residual aneurysmal sac showing wall enhancement, restricted diffusion, and persistent hydrocephalus, as depicted in Figure 3.
case_images: Follow-up MRI at 6 months post-procedure showed a resolving chemical abscess: (a) T1-fat-saturated post-contrast mid-sagittal, (b) T1-fat-saturated post-contrast axial, (c) Diffusion-weighted imaging axial at b 1000 s/mm2 and (d) Apparent diffusion coefficient axial at same level as 4c showing further reduction in the size of the remnant sac and hydrocephalus, persistent peripheral rim enhancement and restricted diffusion.
case_images: SAJR-28-2841-g004.jpg
case_images: PMC11079415_01_SAJR-28-2841-g004.jpg
case_images: F0004
case_images: On MRI there was a reduction in the size of the residual sac and hydrocephalus, albeit with continued restricted diffusion and peripheral mural enhancement, as shown in Figure 4.