Aneurysm vein of Galen (AVG) malformation are rare but form an important diagnostic and therapeutic challenge in pediatric patients. We report yet another unique treatment along with a resin in an infant diagnosed to have AVG on fetal ECHO. The fetus who developed congestive heart failure with manifest edema was treated with embolization using both microcoils (Target therapeutics coil) retrievable (GDC) and nonretrivable followed by embolization using N-Butryl Cyanocrylate (Braun Melsungen Germany). On day 3 of life total of 49 fiber coils were packed into the aneurysm on the first attempt. On day 5 and again on day 7 because of persistence of flow, a mixture of 1 gm tantalum powder, 1 ml of ethiodol and 4 ml of histocryl was injected into AVG. The baby tolerated the procedures well. An intraoperative cranial ultrasound during the final step showed marked regression of the lesion. Serial cardiac ECHO during two weeks of hospital stay showed progressive reduction in ventricular dimensions and improved contractility following embolization. Infant was discharged home on day 15. At 2 months of age he was doing well. A review of articles related to AVG in neonates since 1937 showed that between 1937-82, surgery was the main treatment. During 1982-1990, surgery and embolization were both used with equal frequency. Since 1990's embolization is being increasingly used as treatment. Outcomes of the review are shown in table.

Table 1
Full size table

Conclusion: Overall survial and outcome of AVG has improved since introduction of embolization. Our case shows:1) intrauterine diagnosis of AVG and treatment of fetal CHF is possible, 2) postnatal embolization of AVG using both coils and acrylic glue without subjecting to surgical therapy controls progressive heart failure.