Abstract
BACKGROUND: A vein of Galen aneurysmal malformation (VGAM) is a rare vascular lesion that often requires treatment in the neonatal period or infancy. Neonates and infants have limited catheter access, and the treatment of VGAM often requires multiple procedures. When standard access routes are unavailable, alternative vascular access becomes essential. OBSERVATIONS: A female infant born at 35 weeks 6 days of gestation with a prenatal diagnosis of VGAM developed severe heart failure and anuria after birth. Urgent transarterial glue embolization was performed on days 0 and 1. Three months later, follow-up MRI showed shunt worsening and venous congestion. With no remaining access routes available, the brachial artery was utilized as an alternative, as both femoral arteries were occluded and direct internal carotid artery puncture was unsafe due to the short neck and enlarged jugular vein. After this approach, treatment improved venous congestion and reduced the VGAM shunt without complications, preserving blood flow in the brachial artery. LESSONS: In neonates, maintaining umbilical artery access is crucial to preserving the femoral arteries for future use. However, if these routes are lost due to multiple procedures, the brachial artery can serve as an effective alternative for vascular access. https://thejns.org/doi/10.3171/CASE24861.