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Kurt G, Aslan A, Kara E, Erol G, Şahin MB, Uçar M. Different Aspects on Clinical Presentation of Developmental Venous Anomalies: Are They as Benign as Known? A Single Center Experience. Clin Neurol Neurosurg 2020; 201:106443. [PMID: 33388660 DOI: 10.1016/j.clineuro.2020.106443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cerebral developmental venous anomalies (DVAs) are frequently diagnosed incidentally owing to the advances in neuroimaging. They are regarded as clinically insignificant due to their supposed quiescent existence which the authors aimed to contradict in this paper. AIM In the aim of constituting a better understanding of clinical presentation of DVAs and making an estimation regarding the probability of resulting in a hemorrhage, the authors presented their experiences with a case series of DVAs. METHODS A retrospective analysis was carried out among patients who underwent brain MRI in a radiology department of a university between January of 2019 and January of 2020. RESULTS A total of 101 patients with DVA were extracted. 38 patients had isolated DVAs, while 63 patients had various accompanying cerebral pathologies, mostly cavernomas (39 patients) and AVMs (11 patients). The main complaints leading investigation were headache, dizziness, ataxia, nausea\vomiting, seizures and focal neurological deficits. 41 patients were truly symptomatic with indicative findings of seizures, neurological deficits or intracranial hemorrhages, and 12 of them had solitary DVAs. 22 patients presented with hemorrhages, and of them, 10 had only DVA, while the rest had some associated lesions, most often cavernoma. Of 22 patients with hemorrhage, 5 were operated, 5 were applied radiosurgery; while the rest were followed without any intervention. CONCLUSION Although the symptoms in patients with DVA are generally charged on other associated pathologies, the fact that isolated DVAs may occasionally be problematic in the range of minor symptoms and severe hemorrhage should not be underestimated.
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Affiliation(s)
- Gökhan Kurt
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayfer Aslan
- Department of Neurosurgery, Faculty of Medicine Hitit University, Çorum, Turkey.
| | - Enes Kara
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gökberk Erol
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Merve Büke Şahin
- Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Uçar
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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Pereira VM, Geibprasert S, Krings T, Aurboonyawat T, Ozanne A, Toulgoat F, Pongpech S, Lasjaunias PL. Pathomechanisms of Symptomatic Developmental Venous Anomalies. Stroke 2008; 39:3201-15. [PMID: 18988912 DOI: 10.1161/strokeaha.108.521799] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and Purpose—
Although it is generally accepted that developmental venous anomalies (DVAs) are benign vascular malformations, over the past years, we have seen patients with symptomatic DVAs. Therefore, we performed a retrospective study and a literature study to review how, when, and why DVAs can become clinically significant.
Methods—
Charts and angiographic films of 17 patients with DVAs whose 18 vascular symptoms could be attributed to a DVA were selected from a neurovascular databank of our hospital. MRI had to be available to rule out any other associated disease. In the literature, 51 cases of well-documented symptomatic DVAs were found. Pathomechanisms were divided into mechanical and flow-related causes.
Results—
Mechanical (obstructive or compressive) pathomechanisms accounted for 14 of 69 symptomatic patients resulting in hydrocephalus or nerve compression syndromes. Flow-related pathomechanisms (49 of 69 patients) could be subdivided into complications resulting from an increase of flow into the DVA (owing to an arteriovenous shunt using the DVA as the drainage route; n=19) or a decrease of outflow (n=26) or a remote shunt with increased venous pressure (n=4) leading to symptoms of venous congestion. In 6 cases, no specific pathomechanisms were detected.
Conclusions—
Although DVAs should be considered benign, under rare circumstances, they can be symptomatic. DVAs, as extreme variations of normal venous drainage, may represent a more fragile venous drainage system that can be more easily affected by in- and outflow alterations. The integrity of the DVA needs to be preserved irrespective of the treatment that should be tailored to the specific pathomechanism.
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Affiliation(s)
- Vitor M. Pereira
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Sasikhan Geibprasert
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Timo Krings
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Thaweesak Aurboonyawat
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Augustin Ozanne
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Frederique Toulgoat
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Sirintara Pongpech
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Pierre L. Lasjaunias
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
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