[Prenatal ultrasonography in the diagnosis of vein of Galen aneurysm]. / Ultra-sonografia pré-natal no diagnóstico de aneurisma da veia de Galeno.

Vein of Galen aneurysm is a rare congenital anomaly, originated from a defect in fusion of internal cerebral veins. Due to low resistance, it produces high debit cardiac insufficiency. It constitutes 1% of all intracranial vascular malformations. Prognosis depends on patient's age when the manifestation occurs and aneurysm size. The two reported cases are about fetal prenatal diagnosis of vein of Galen aneurysm, confirmed by ultrasonography, which evolved for caesarian delivery at term gestation. Magnetic resonance was carried out after birth, confirming prenatal diagnosis. The first patient had spontaneous thrombosis of the aneurysm while the second was submitted to embolization. Both of them had hospital discharge with ambulatory accompaniment. The prenatal ultrasonography diagnosis is fundamental to determine aneurysm size, defining the best treatment, when this procedure is indicated, and the more adequate obstetric and perinatal assistance.

[Intrapartum management strategies for congenital cervical teratoma: the EXIT procedure (ex utero intrapartum treatment)]. / Estratégia de conduta intraparto no teratoma cervical congênito: procedimento EXIT (tratamento extra-útero intraparto).

Cervical teratomas are 3 to 5% of all teratomas and have an incidence of 1:20,000 to 1:40,000 live-borns. M.J.F., 31-years-old, had done a routine scan during pregnancy that evidenced a large fetal neck mass with teratoma cervical sonographic aspect. An interdisciplinary reunion decided for expectant management until pregnancy term when C section with EXIT procedure would be performed. At 34 weeks occurred spontaneous preterm labor and the interdisciplinary team was contacted. After head exteriorization a large neck mass was noticed. The EXIT procedure was performed allowing a tranquil orotracheal intubation while placental circulation was sustained. At third day the patient presented hypoxia, decreased heart rate and central cyanosis developing cardiorespiratory failure with unsuccessful response to resuscitation. Cervical teratoma is a rare fetal condition that is very important an interdisciplinary approach performing EXIT procedure to allow an adequate respiratory assistance at delivery. Intensive neonatal care is essential to improve patient outcome.