The vein of Galen aneurysmal malformation (VGAM) is a rare congenital arteriovenous fistula of the embryonic prosencephalic vein of Markowski, leading to pathological dilatation of the vein. If left untreated, it can lead to multiple complications in the neonatal period, including 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, which was diagnosed by magnetic resonance imaging and angiography. The hydrocephalus was treated by a third ventriculostomy at the age of six months, while the VGAM underwent partial transvenous endovascular embolization of the posterior choroidal feeders at the age of four years; the procedures were successful and no postoperative complications were observed. The epileptic seizures started later and were successfully treated with valproate. However, they resumed after the patient's parents reduced the dosage. The patient was restarted on an appropriate dose of valproic acid and his parents reported no further seizures. This case report highlights the use of appropriate prenatal and neonatal diagnostic methods for VGAM. It explores the nature of the multi-procedural therapeutic approach to the pathology and its complications in the presence of a co-morbidity, namely epilepsy.

Plamen Penchev is a fourth-year medical student at the Medical University of Plovdiv, Bulgaria. He is the president and co-founder of the Bulgarian students club of neuroscience “Neurologica”. He has published 17 articles (7 with IF) and has 23 abstracts presented with oral presentations at conferences in Bulgaria and Europe, some of which he had won prizes for best presentation. Most recently, he won 1st place at the International Trauma Conference in London, UK. He is a peer-reviewer at Open Access Macedonian Journal of Medical Sciences for which he has written 10 peer reviews for articles in the field of neurosurgery. He is a member of the international neurosurgical society “Walter Dandy” and the European Association of Neurosurgical Societies.