The Management of Symptomatic Cerebral Developmental Venous Anomalies: A Clinical Experience of 43 Cases

Abstract

BackgroundDevelopmental venous anomalies (DVAs) are rare vascular diseases becoming more frequently diagnosed. Most patients with DVAs have no clinical symptoms with the exception of a few patients with epilepsy, intracranial hemorrhage, or neuro-function deficit. There is still controversy with respect to treatment strategies for symptomatic DVAs.Material/MethodsForty-three cases of symptomatic DVAs from January 2006 to October 2015 were retrospectively reviewed and the imaging characteristics of DVAs by CT, MRI, and DSA and the treatment modalities for DVAs were studied.ResultsTypical imaging characteristics of symptomatic DVAs were wedge or umbrella-shaped collections of dilated medullary veins converging in an enlarged subependymal or transcortical collecting vein, draining to the superficial or deep vein system. Based on location and draining vein features, symptomatic DVAs were tentatively classified into six different subtypes. Of the 43 cases, 19 were treated by surgical methods and 24 were treated conservatively.ConclusionsWe concluded that the rate of accompanying abnormalities in cases of symptomatic DVAs was high. Intracerebral hemorrhage was usually attributed to associated CMs or AVMs. The associated lesions and the branches responsible for bleeding could be resected while preserving the collecting vein as far as possible.

Clinical and Arterial Spin Labeling Brain MRI Features of Transitional Venous Anomalies

“…Previous reports and series of TVAs in the literature are consistent with this, as only a limited number of cases have been described . The vast majority of published case reports, case series, and studies have described the complications of TVAs, especially in association with hemorrhage, but these series and studies were biased, reflecting evaluation of a patient population presenting acutely with critical symptoms . By comparison, our study screened for the presence of any potential TVA on ASL‐MRI whether or not the lesion could be responsible for the patient's presenting symptoms or indication for the scan.…”

Developmental Venous Anomalies and Epilepsy

“…Тип E: располагаются в стволе мозга. Тип F: располагаются подкожно или в области околоносовой пазухи [8].…”

“…По данным других литературных источников, найден 21 опубликованный клинический случай эпилептических приступов, вызванных осложнениями ВАР, и 9 клинических случаев, в которых возможна прямая связь между эпилепсией и изолированной неосложненной ВАР [3,4,[6][7][8]. Эпилептические приступы ассоциированные с ВАР, преимущественно связаны с наличием эпилептогенного поражения, такого как кавернозная мальформация, дисплазия или осложнения в области ВАР.…”

“…У пациентов с ВАР зарегистрирована более высокая частота эпилепсии по сравнению с таковой среди населения в целом [8,18,19,21,22], что может быть обусловлено наличием коркового гипометаболизма, связанного с ВАР [21,23].…”

Medusa-like Atypical Intracerebral Vein: A Rare Case of Symptomatic Developmental Venous Anomaly

“…Neurosurgical intervention is not a choice for the treatment of isolated DVAs because this on its own can lead to unacceptable consequences (7,21,22). Therefore, excision or ablation of DVAs should be avoided because they may form part of the normal venous drainage for adjacent normal neural tissue.…”