# Epileptic Seizures in a Pediatric Patient With Vein of Galen Aneurysmal Malformation and Obstructive Hydrocephalus: A Rare Case Report

## TL;DR

A six-year-old boy with a rare vein of Galen malformation and hydrocephalus experienced epileptic seizures, which were managed with medication after initial successful treatments.

## Contribution

This case highlights the importance of early diagnosis and multi-procedural therapy for managing VGAM and its complications, including epilepsy.

## Key findings

- VGAM and obstructive hydrocephalus were successfully treated with ventriculostomy and endovascular embolization.
- Epileptic seizures were controlled with valproate but recurred when the dosage was reduced.
- The case underscores the need for consistent medication adherence and comprehensive management strategies.

## Abstract

The vein of Galen aneurysmal malformation (VGAM) is a rare congenital arteriovenous fistula of the embryonic median prosencephalic vein of Markowski, resulting in its pathological dilation. If left untreated, it can lead to multiple severe complications in the neonatal period, among which obstructive hydrocephalus. We present a case report of a six-year-old male patient with severe status epilepticus and a clinical history of VGAM and obstructive hydrocephalus, diagnosed via an MRI and an MR-angiography. The hydrocephalus was treated via a ventriculostomy at the age of six months, while the VGAM underwent a partial transarterial endovascular embolization when the patient was four years old. The procedures were successful, and there were no significant post-operative complications observed. The epileptic seizures began at a later point and were successfully medicated with valproate. However, they resumed due to a lowering of the medication dosage by the patient’s parents. The patient was given a new valproic acid regimen with an appropriate dosage, and his parents reported no further seizures. This case report emphasizes the use of appropriate prenatal and neonatal diagnostic methods for VGAM and explores the nature of the multi-procedural therapy approach towards the pathology and its complications in relation to a possibly idiopathic co-pathology, namely epilepsy.