1
|
Ma L, Hoz SS, Grossberg JA, Lang MJ, Gross BA. Developmental Venous Anomalies. Neurosurg Clin N Am 2024; 35:355-361. [PMID: 38782528 DOI: 10.1016/j.nec.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Developmental venous anomalies (DVAs) are the most common vascular malformation detected on intracranial cross-sectional imaging. They are generally benign lesions thought to drain normal parenchyma. Spontaneous hemorrhages attributed to DVAs are rare and should be ascribed to associated cerebral cavernous malformations, flow-related shunts, or venous outflow obstruction. Contrast-enhanced MRI, susceptibility-weighted imaging, and high-field MRI are ideal tools for visualizing vessel connectivity and associated lesions. DVAs are not generally considered targets for treatment. Preservation of DVAs is an established practice in the microsurgical or radiosurgical treatment of associated lesions.
Collapse
Affiliation(s)
- Li Ma
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Samer S Hoz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | | | - Michael J Lang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| |
Collapse
|
2
|
Demir MK, Kılıc D, Zorlu E, Kılıc T. Giant Intracranial Cavernous Malformations: A Review on Magnetic Resonance Imaging Characteristics. Indian J Radiol Imaging 2024; 34:511-521. [PMID: 38912256 PMCID: PMC11188748 DOI: 10.1055/s-0044-1779587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background Intracranial cavernous malformations (CMs), commonly known as cavernomas or cavernous angiomas, are low-flow, well-circumscribed vascular lesions composed of sinusoidal spaces lined by a single layer of endothelium and separated by a collagenous matrix without elastin, smooth muscle, or other vascular wall elements. A diameter greater than 3 cm for a CM is unlikely. These lesions may have atypical appearances on magnetic resonance imaging (MRI). MRI with advanced techniques such as a susceptibility-weighted image or T2-gradient echo, a diffusion-weighted image and corresponding apparent diffusion coefficient map, and diffusion tensor tractography have revolutionized the diagnostic approach to these lesions. Materials and Method The present study reviews the etiopathogenesis, clinical manifestations, MRI strategy, and MRI appearances of the CMs, with a few examples of the giant CMs from our archive. Results Intracranial giant CMs may have unexpected locations, sizes, numbers, and varied imaging appearances due to repeated hemorrhages, unusual enhancement patterns, intense perifocal edema, and unusual associations, making the differential diagnosis difficult. Conclusion Familiarity with the MRI appearances of the giant intracranial CMs and the differential diagnosis improves diagnostic accuracy and patient management.
Collapse
Affiliation(s)
- Mustafa Kemal Demir
- Clinic of Radiology, Bahcesehir University Goztepe Medical Park Hospital, Istanbul, Turkey
| | - Deniz Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Emre Zorlu
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Turker Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Horsch S, Schwarz S, Arnaez J, Steggerda S, Arena R, Govaert P. Cerebral Doppler imaging in neonates: A guide for clinical application and diagnosis. Dev Med Child Neurol 2024. [PMID: 38940604 DOI: 10.1111/dmcn.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 04/30/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024]
Abstract
Cranial ultrasound reliably diagnoses many neonatal brain disorders. Adding Doppler imaging expands the spectrum by providing information on the status of the vasculature and haemodynamics that may guide further diagnostic and clinical management. Doppler imaging may identify neonates with congenital or acquired vascular abnormalities such as perinatal stroke, sinuvenous thrombosis, vein of Galen malformation, dural sinus malformation, sinus pericranii, and developmental venous anomaly. These entities may need further investigation with complementary imaging modalities such as magnetic resonance imaging and magnetic resonance angiography, or conventional angiography. This review aims to help clinicians to improve their Doppler sonography knowledge and skills in order to use this helpful tool in neonates with neurological symptoms or suspected cerebral vascular abnormalities admitted to the neonatal intensive care unit.
Collapse
Affiliation(s)
- Sandra Horsch
- Department of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Simone Schwarz
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Clinics, Duisburg, Germany
| | - Juan Arnaez
- Hospital Universitario de Burgos, Burgos, Spain
- Neonatal Neurology, NeNe Foundation, Madrid, Spain
| | - Sylke Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roberta Arena
- Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Paul Govaert
- Department of Neonatology, UZBrussel, Brussels, Belgium
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
| |
Collapse
|
4
|
Dulamea AO, Lupescu IC. Cerebral cavernous malformations - An overview on genetics, clinical aspects and therapeutic strategies. J Neurol Sci 2024; 461:123044. [PMID: 38749279 DOI: 10.1016/j.jns.2024.123044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024]
Abstract
Cerebral cavernous malformations (CCMs) are abnormally packed blood vessels lined with endothelial cells, that do not exhibit intervening tight junctions, lack muscular and elastic layers and are usually surrounded by hemosiderin and gliosis. CCMs may be sporadic or familial autosomal dominant (FCCMs) caused by loss of function mutations in CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10) genes. In the FCCMs, patients have multiple CCMs, different family members are affected, and developmental venous anomalies are absent. CCMs may be asymptomatic or may manifest with focal neurological deficits with or without associated hemorrhage andseizures. Recent studies identify a digenic "triple-hit" mechanism involving the aquisition of three distinct genetic mutations that culminate in phosphatidylinositol-3-kinase (PIK3CA) gain of function, as the basis for rapidly growing and clinically symptomatic CCMs. The pathophysiology of CCMs involves signaling aberrations in the neurovascular unit, including proliferative dysangiogenesis, blood-brain barrier hyperpermeability, inflammation and immune mediated processes, anticoagulant vascular domain, and gut microbiome-driven mechanisms. Clinical trials are investigating potential therapies, magnetic resonance imaging and plasma biomarkers for hemorrhage and CCMs-related epilepsy, as well as different techniques of neuronavigation and neurosonology to guide surgery in order to minimize post-operatory morbidity and mortality. This review addresses the recent data about the natural history, genetics, neuroimaging and therapeutic approaches for CCMs.
Collapse
Affiliation(s)
- Adriana Octaviana Dulamea
- Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; Fundeni Clinical Institute, Department of Neurology, 258 Fundeni Street, 022328 Bucharest, Romania.
| | - Ioan Cristian Lupescu
- Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; Fundeni Clinical Institute, Department of Neurology, 258 Fundeni Street, 022328 Bucharest, Romania
| |
Collapse
|
5
|
Motoyama Y, Sasaki H, Nakajima T, Hayami H, Matsuoka R, Fukutome K, Tei R, Shin Y, Aketa S. Eagle jugular syndrome accompanied by de novo brainstem cavernous malformation: a case-based systematic review. Acta Neurochir (Wien) 2024; 166:20. [PMID: 38231302 DOI: 10.1007/s00701-024-05900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Eagle jugular syndrome (EJS), recently identified as a cause of cerebrovascular disease (CVD) due to venous obstruction by an elongated styloid process (SP), is reported here alongside a case of concurrent de novo cerebral cavernous malformation (CCM). This study aims to explore the potential causal relationship between EJS and de novo CCM through a comprehensive literature review. METHOD Systematic literature reviews, spanning from 1995 to 2023, focused on EJS cases with definitive signs and symptoms and de novo CCM cases with detailed clinical characteristics. Data on the pathophysiology and clinical manifestations of EJS, as well as potential risk factors preceding de novo CCM, were collected to assess the relationship between the two conditions. RESULT Among 14 patients from 11 articles on EJS, the most common presentation was increased intracranial hypertension (IIH), observed in 10 patients (71.4%), followed by dural sinus thrombosis in four patients (28.6%). In contrast, 30 patients from 28 articles were identified with de novo CCM, involving 37 lesions. In these cases, 13 patients developed CCM subsequent to developmental venous anomalies (43%), seven following dural arteriovenous fistula (dAVF) (23%), and two after sinus thrombosis (6%). In a specific case of de novo brainstem CCM, the development of an enlarged condylar emissary vein, indicative of venous congestion due to IJV compression by the elongated SP, was noted before the emergence of CCM. CONCLUSION This study underscores that venous congestion, a primary result of symptomatic EJS, might lead to the development of de novo CCM. Thus, EJS could potentially be an indicator of CCM development. Further epidemiological and pathophysiological investigations focusing on venous circulation are necessary to clarify the causal relationship between EJS and CCM.
Collapse
Affiliation(s)
- Yasushi Motoyama
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan.
| | - Hiromitsu Sasaki
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Tsukasa Nakajima
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Hiromichi Hayami
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Ryuta Matsuoka
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Kenji Fukutome
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Rinsei Tei
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Yasushi Shin
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Shuta Aketa
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| |
Collapse
|
6
|
Abdulaal MA, Ali FM, Rabea ZH, Husain AM, Naser ZA, Mohamed SK, Abdulla ZA, Alharbi A. Occipital Lobe Cavernoma Presenting With Headaches and Visual Hallucinations: A Case Report. Cureus 2024; 16:e51506. [PMID: 38304654 PMCID: PMC10831919 DOI: 10.7759/cureus.51506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Cavernomas, also known as cavernous angiomas or cavernous malformations, are rare vascular lesions characterized by abnormal clusters of dilated capillaries without intervening brain tissue. While often asymptomatic, they can manifest with neurological symptoms such as headaches, seizures, and focal deficits. We present a case of a 45-year-old male who presented with persistent headaches and visual hallucinations. Thorough clinical assessment revealed intermittent throbbing headaches localized to the left occipital region, accompanied by brief episodes of vivid visual hallucinations. Extensive work-up, including laboratory tests and neuroimaging, identified a subependymal cavernoma in the left occipital lobe. A surgical excision was performed, resulting in sustained relief from headaches and the absence of visual hallucinations during follow-up examinations. This case contributes to the understanding of cavernomas by detailing the clinical presentation, diagnostic process, and successful surgical intervention for a subependymal cavernoma in the left occipital lobe. The resolution of symptoms postoperatively underscores the importance of individualized treatment approaches, considering factors such as lesion location, patient age, and associated risks. The case highlights the evolving knowledge in cavernoma management and emphasizes the need for tailored therapeutic decisions in addressing neurovascular disorders.
Collapse
Affiliation(s)
| | - Fatema M Ali
- General Practice, Al Hilal Multi Specialty Medical Center, Hamad Town, BHR
| | - Zainab H Rabea
- General Practice, RAK (Ras Al Khaimah) Medical & Health Sciences University, Ras Al Khaimah, ARE
| | | | | | | | | | - Ahlam Alharbi
- Family Medicine, Primary Health Care Center, Riyadh, SAU
| |
Collapse
|
7
|
Galvão GDF, Filho RC, Cunha AAM, Soares AG, Filho MAD, de Souza JM. Infratentorial Cerebral Cavernous Malformation May be a Risk Factor for Symptomatic Bleeding and Precocity of Symptoms: A Multicenter, Propensity Score Matched, Case-Control Study. Curr Neurovasc Res 2024; 21:177-183. [PMID: 38482623 DOI: 10.2174/0115672026304601240307051654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Cerebral Cavernous Malformation (CCM) is one of the most common types of vascular malformation of the central nervous system. Intracerebral hemorrhage, seizures, and lesional growth are the main clinical manifestations. Natural history studies have tried to identify many risk factors; however, the clinical course remains highly unpredictable. OBJECTIVE Here, we have analyzed a multicenter CCM cohort looking for the differential clinical data regarding the patients harboring supra and/or infratentorial cavernous malformations in order to better understand risk factors involved in the anatomical location of the unique neurosurgical disease. METHODS We have presented a multicenter, Propensity Score Matched (PSM), case-control study including 149 consecutive CCM cases clinically evaluated from May 2017 to December 2022 from three different neurosurgical centers. Epidemiological data were defined at each clinical assessment. Logistic regression was used to identify the independent contribution of each possible risk factor to the bleeding risk. To balance baseline covariates between patients with and without symptoms, and specifically between those with and without symptomatic bleeding, we used a PSM strategy. The Kaplan-Meier curve was drawn to evaluate if patients with infratentorial lesions had a greater chance of bleeding earlier in their life. RESULTS The presence of infratentorial lesions was a risk factor in the multivariate analysis comparing the bleeding risk with pure asymptomatic individuals (OR: 3.23, 95% CI 1.43 - 7.26, P = 0.005). Also, having an infratentorial CCM was a risk factor after PSM (OR: 4.56, 95% CI 1.47 - 14.10, P = 0.008). The presence of an infratentorial lesion was related to precocity of symptoms when the time to first bleed was compared to all other clinical presentations in the overall cohort (P = 0.0328) and in the PSM group (P = 0.03). CONCLUSION Here, we have provided some evidence that infratentorial cerebral cavernous malformation may have a more aggressive clinical course, being a risk factor for symptomatic haemorrhage and precocity of bleeding.
Collapse
Affiliation(s)
- Gustavo da Fontoura Galvão
- Department of de Neurosurgery, Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Rio de Janeiro RJ, Brazil
| | - Ricardo Castro Filho
- Department of de Neurosurgery, Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Rio de Janeiro RJ, Brazil
| | - Alexandre Alexandre Martins Cunha
- Department of de Neurosurgery, Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Rio de Janeiro RJ, Brazil
- Department of de Neurosurgery, State University of Rio de Janeiro, University Hospital Pedro Ernesto, Rio de Janeiro RJ, Brazil
| | | | | | - Jorge Marcondes de Souza
- Department of de Neurosurgery, Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Rio de Janeiro RJ, Brazil
| |
Collapse
|
8
|
Cogswell PM, Pillai JJ, Lanzino G, Flemming KD. Prevalence of Developmental Venous Anomalies in Association with Sporadic Cavernous Malformations on 7T MRI. AJNR Am J Neuroradiol 2023; 45:72-75. [PMID: 38123913 PMCID: PMC10756565 DOI: 10.3174/ajnr.a8072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND PURPOSE The etiology of sporadic cavernous malformations is not well-understood. However, recent evidence suggests that they may arise from a developmental venous anomaly. The goal of this study was to evaluate the prevalence of developmental venous anomalies associated with sporadic cavernous malformations using 7T MR imaging. MATERIALS AND METHODS We retrospectively identified patients with a sporadic cavernous malformation imaged with 7T MR imaging between August 2019 and July 2022. Two raters determined whether a developmental venous anomaly was associated with each malformation. RESULTS The study included 59 patients with a total of 61 cavernous malformations. Of the sixty-one, 44 (72%) had an associated developmental venous anomaly. An associated anomaly was most common for cavernous malformations in the brainstem (88%) compared with the cerebral hemispheres or cerebellum (60%-67%). CONCLUSIONS By means of high-quality 7T imaging, most patients with a sporadic cavernous malformation were found to have an associated developmental venous anomaly. These findings support the hypothesis that cavernous malformations may arise secondary to hemodynamic abnormalities.
Collapse
Affiliation(s)
- Petrice M Cogswell
- From the Department of Radiology (P.M.C., J.J.P., G.L.), Mayo Clinic, Rochester, Minnesota
| | - Jay J Pillai
- From the Department of Radiology (P.M.C., J.J.P., G.L.), Mayo Clinic, Rochester, Minnesota
| | - Giuseppe Lanzino
- From the Department of Radiology (P.M.C., J.J.P., G.L.), Mayo Clinic, Rochester, Minnesota
- Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - Kelly D Flemming
- Department of Neurology (K.D.F.), Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
9
|
Antonelli V, Maimone G, Fuschillo D, Turrini A, Draghi R, Riccioni L, Calbucci F, Tosatto L. De novo cavernous angiomas associated with developmental venous anomaly: a mini-series and literature review. J Neurosurg Sci 2023; 67:758-766. [PMID: 35301833 DOI: 10.23736/s0390-5616.21.05512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite being previously considered as congenital lesions, recent studies agree to classify cerebral cavernous malformations (CCM) as acquired forms with clear correlations with other pathological affections of the central nervous system (CNS). In addition, a special subgroup, notably known as de novo CCMs (dnCCM), are associated in a significant number of cases with developmental venous anomalies (DVAs) and, in other cases, with Radiotherapy treatments. METHODS A mini-series of 4 patients with clinical history characterized by developing dnCCM is reported. In three patients, the dnCCM was associated with the presence of an isolated DVA. In one case, no DVA was detected, but the patient underwent brain radiotherapy. In three cases, the dnCCM was clinically symptomatic, and the patients were submitted to a surgical procedure for lesion removal. In one case, the dnCCM was detected during MRI follow-up. RESULTS Adding a review of the literature, we describe 47 patients who presented dnCCMs. The most common presentation is a sporadic CCM with a DVA, and the onset presentation was bleeding in 4 out of 47 cases (8.5%). Bleeding of dnCCM was observed in 9 out of 47 cases (19%), and the choice treatment was surgical in 24 out of 47 cases (51%). CONCLUSIONS We present our series with a review of the recent literature and discuss the "de novo" cavernous malformation pathogenesis. A throughout review of recent literature is reported to clarify the predisposing factors that may lead to dnCCM development in patients carrying specific genetic and molecular features. Considering the high risk of bleeding, strict follow-up and aggressive treatment should be evaluated in dnCCM management.
Collapse
Affiliation(s)
- Vincenzo Antonelli
- Department of Neurosurgery, M. Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Giuseppe Maimone
- Department of Neurosurgery, M. Bufalini Hospital, Cesena, Forlì-Cesena, Italy -
| | - Dalila Fuschillo
- Department of Neurosurgery, M. Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Alessandra Turrini
- Department of Neurosurgery, M. Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Riccardo Draghi
- Department of Neurosurgery, Villa Maria Hospital, Cotignola, Ravenna, Italy
| | - Luca Riccioni
- Department of Pathology, M. Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Fabio Calbucci
- Department of Neurosurgery, Villa Maria Hospital, Cotignola, Ravenna, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, M. Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| |
Collapse
|
10
|
Ahmed S, Saini J, Gorantla P, Kulanthaivelu K, Shashidhar A, Deora H, Holla VV, Arora A. An Illustrative Review of the Pathomechanisms of Symptomatic Developmental Venous Anomalies. J Comput Assist Tomogr 2023; 47:940-950. [PMID: 37948370 DOI: 10.1097/rct.0000000000001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Symptomatic developmental venous anomalies (DVAs) are rare. Here, we illustrate the varied clinicoradiologic profiles of symptomatic DVAs and contemplate the mechanisms that render these (allegedly) benign entities symptomatic supported by a review of literature. METHODS Institutional databases were searched to identify cases of symptomatic DVAs. Clinical and imaging (angiographic and cross-sectional) data of 9 cases with 11 neurovascular symptoms consequent to inflow/outflow perturbations and mechanical obstruction that manifested because of the strategic topography of underlying DVAs were analyzed. A review of the existing literature on DVAs in agreement with our case series was performed on publications retrieved from the PubMed database. RESULTS Symptoms secondary to venous hypertension arising from flow-related perturbations were broadly divided into those arising from restricted outflow and increased inflow. Restricted outflow occurred because of collector vein stenosis (n = 2) and collector vein/DVA thrombosis (n = 3), whereas the latter pathomechanism was initiated by arterialized/transitional DVAs (n = 2). A mechanical/obstructive pathomechanism culminating in moderate supratentorial ventriculomegaly was noted in 1 case. One patient was given a diagnosis of hemorrhage associated with a cavernoma. CONCLUSIONS Awareness and contextualization of potential flow-related perturbations and mechanical insults that render DVAs symptomatic aid in accurate diagnosis, management, and prognostication.
Collapse
Affiliation(s)
- Sabha Ahmed
- From the Departments of Neuroimaging and Interventional Radiology
| | - Jitender Saini
- From the Departments of Neuroimaging and Interventional Radiology
| | | | | | - Abhinith Shashidhar
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harsh Deora
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vikram V Holla
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ankit Arora
- From the Departments of Neuroimaging and Interventional Radiology
| |
Collapse
|
11
|
Patel A, Valle D, Nguyen A, Molina E, Lucke-Wold B. Role of Genetics and Surgical Interventions for the Management of Cerebral Cavernous Malformations (CMM). CURRENT CHINESE SCIENCE 2023; 3:386-395. [PMID: 37981909 PMCID: PMC10657140 DOI: 10.2174/2210298103666230823094431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/21/2023] [Accepted: 07/14/2023] [Indexed: 11/21/2023]
Abstract
Cerebral cavernous malformations (CCMs) are comprised of tissue matter within the brain possessing anomalous vascular architecture. In totality, the dilated appearance of the cavernomatakes on a mulberry-like shape contributed by the shape and relation to vascular and capillary elements. Analyzing its pathophysiology along with its molecular and genetic pathways plays a vital role in whether or not a patient receives GKRS, medical management, or Surgery, the most invasive of procedures. To avoid neurological trauma, microsurgical resection of cavernomas canbe guided by the novel clinical application of a 3D Slicer with Sina/MosoCam. When cavernomas present in deep lesions with poor accessibility, gamma knife stereotactic radiosurgery (GKSR) is recommended. For asymptomatic and non-multilobal lesions, medical and symptom management is deemed standard, such as antiepileptic therapy. The two-hit hypothesis serves to explain the mutations in three key genes that are most pertinent to the progression of cavernomas: CCM1/KRIT1, CCM2/Malcavernin, and CCM3/PDCD10. Various exon deletions and frameshift mutations can cause dysfunction in vascular structure through loss and gain of function mutations. MEKK3 and KLF2/4 are involved in a protein kinase signaling cycle that promotes abnormal angiogenesis and cavernoma formation. In terms of potential treatments, RhoKinase inhibitors have shown to decrease endothelial to mesenchymal transition and CCM lesion development in mice models. All in all, understanding the research behind the molecular genetics in CCMs can foster personalized medicine and potentially create new neurosurgical and medicative treatments.
Collapse
Affiliation(s)
- Anjali Patel
- Department of Neurosurgery, College of Medicine, University of Florida, Florida 32013, United States
| | - Daisy Valle
- Department of Neurosurgery, College of Medicine, University of Florida, Florida 32013, United States
| | - Andrew Nguyen
- Department of Neurosurgery, College of Medicine, University of Florida, Florida 32013, United States
| | - Eduardo Molina
- Department of Neurosurgery, College of Medicine, University of Florida, Florida 32013, United States
| | - Brandon Lucke-Wold
- Department of Neurosurgery, College of Medicine, University of Florida, Florida 32013, United States
| |
Collapse
|
12
|
Yuzkan S. Developmental venous anomalies look like a spider's feet. J Clin Neurosci 2023; 112:38-40. [PMID: 37054584 DOI: 10.1016/j.jocn.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Sabahattin Yuzkan
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, 34480 Istanbul, Turkey.
| |
Collapse
|
13
|
Bianconi A, Salvati LF, Perrelli A, Ferraris C, Massara A, Minardi M, Aruta G, Rosso M, Massa Micon B, Garbossa D, Retta SF. Distant Recurrence of a Cerebral Cavernous Malformation in the Vicinity of a Developmental Venous Anomaly: Case Report of Local Oxy-Inflammatory Events. Int J Mol Sci 2022; 23:ijms232314643. [PMID: 36498972 PMCID: PMC9736411 DOI: 10.3390/ijms232314643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cerebral cavernous malformations (CCMs) are a major type of cerebrovascular lesions of proven genetic origin that occur in either sporadic (sCCM) or familial (fCCM) forms, the latter being inherited as an autosomal dominant condition linked to loss-of-function mutations in three known CCM genes. In contrast to fCCMs, sCCMs are rarely linked to mutations in CCM genes and are instead commonly and peculiarly associated with developmental venous anomalies (DVAs), suggesting distinct origins and common pathogenic mechanisms. CASE REPORT A hemorrhagic sCCM in the right frontal lobe of the brain was surgically excised from a symptomatic 3 year old patient, preserving intact and pervious the associated DVA. MRI follow-up examination performed periodically up to 15 years after neurosurgery intervention demonstrated complete removal of the CCM lesion and no residual or relapse signs. However, 18 years after surgery, the patient experienced acute episodes of paresthesia due to a distant recurrence of a new hemorrhagic CCM lesion located within the same area as the previous one. A new surgical intervention was, therefore, necessary, which was again limited to the CCM without affecting the pre-existing DVA. Subsequent follow-up examination by contrast-enhanced MRI evidenced a persistent pattern of signal-intensity abnormalities in the bed of the DVA, including hyperintense gliotic areas, suggesting chronic inflammatory conditions. CONCLUSIONS This case report highlights the possibility of long-term distant recurrence of hemorrhagic sCCMs associated with a DVA, suggesting that such recurrence is secondary to focal sterile inflammatory conditions generated by the DVA.
Collapse
Affiliation(s)
- Andrea Bianconi
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, City of Health and Science and University of Turin, 10124 Torino, Italy
- CCM Italia Research Network, National Coordination Center, Department of Clinical and Biological Sciences, University of Turin, 10124 Orbassano, Italy
- Correspondence: (A.B.); (S.F.R.)
| | | | - Andrea Perrelli
- CCM Italia Research Network, National Coordination Center, Department of Clinical and Biological Sciences, University of Turin, 10124 Orbassano, Italy
- Department of Clinical and Biological Sciences, School of Medicine and Surgery, University of Turin, Regione Gonzole 10, 10124 Orbassano, Italy
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY 14602, USA
| | - Chiara Ferraris
- CCM Italia Research Network, National Coordination Center, Department of Clinical and Biological Sciences, University of Turin, 10124 Orbassano, Italy
- Department of Clinical and Biological Sciences, School of Medicine and Surgery, University of Turin, Regione Gonzole 10, 10124 Orbassano, Italy
| | - Armando Massara
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, City of Health and Science and University of Turin, 10124 Torino, Italy
| | - Massimiliano Minardi
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, City of Health and Science and University of Turin, 10124 Torino, Italy
| | - Gelsomina Aruta
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, City of Health and Science and University of Turin, 10124 Torino, Italy
| | - Miriam Rosso
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, City of Health and Science and University of Turin, 10124 Torino, Italy
| | - Barbara Massa Micon
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, City of Health and Science and University of Turin, 10124 Torino, Italy
| | - Diego Garbossa
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, City of Health and Science and University of Turin, 10124 Torino, Italy
- CCM Italia Research Network, National Coordination Center, Department of Clinical and Biological Sciences, University of Turin, 10124 Orbassano, Italy
| | - Saverio Francesco Retta
- CCM Italia Research Network, National Coordination Center, Department of Clinical and Biological Sciences, University of Turin, 10124 Orbassano, Italy
- Department of Clinical and Biological Sciences, School of Medicine and Surgery, University of Turin, Regione Gonzole 10, 10124 Orbassano, Italy
- Correspondence: (A.B.); (S.F.R.)
| |
Collapse
|
14
|
Identification of a novel LATS1 variant associated with familial cerebral cavernous malformations in a Chinese family. Neurol Sci 2022; 43:6389-6397. [DOI: 10.1007/s10072-022-06323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
|
15
|
Zhang J, Abou-Fadel J, Renteria M, Belkin O, Chen B, Zhu Y, Dammann P, Rigamonti D. Cerebral cavernous malformations do not fall in the spectrum of PIK3CA-related overgrowth. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-328901. [PMID: 35477890 DOI: 10.1136/jnnp-2022-328901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/23/2022] [Indexed: 11/04/2022]
Abstract
Somatic gain-of-function (GOF) mutations in phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), the catalytic subunit of phosphoinositide 3-kinase (PI3K), have been recently discovered in cerebral cavernous malformations (CCMs), raising the possibility that the activation of PI3K pathways is a possible universal regulator of vascular morphogenesis. However, there have been contradicting data presented among various groups and studies. To enhance the current understanding of vascular anomalies, it is essential to explore this possible relationship between altered PI3K signalling pathways and its influence on the pathogenesis of CCMs. GOF PIK3CA-mutants have been linked to overgrowth syndromes, allowing this group of disorders, resulting from somatic activating mutations in PIK3CA, to be collectively named as PIK3CA-related overgrowth spectrum disorders. This paper reviews and attempts to conceptualise the relationships and differences among clinical presentations, genotypic and phenotypic correlations and possible coexistence of PIK3CA and CCM mutations/phenotypes in CCM lesions. Finally, we present a model reflecting our hypothetical understanding of CCM pathogenesis based on a systematic review and conceptualisation of data obtained from other studies.
Collapse
Affiliation(s)
- Jun Zhang
- Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Johnathan Abou-Fadel
- Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Mellisa Renteria
- Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Ofek Belkin
- Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Bixia Chen
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Germany
| | - Yuan Zhu
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
16
|
Taydas O, Ogul H, Kantarci M. An analysis of lesions associated with developmental venous anomalies. Ann R Coll Surg Engl 2021; 103:768-774. [PMID: 34448641 DOI: 10.1308/rcsann.2021.0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe different lesions and features associated with developmental venous anomalies (DVAs). METHODS The records and magnetic resonance imaging (MRI) images of 1,722 patients who underwent cranial MRI between 2010 and 2017 were retrospectively reviewed. It was found that 124 (7.2%) patients had DVAs, and 48 of these patients (38.7%) had additional anomalies accompanying DVAs. Of the patients with DVAs, 25 were female and 23 were male, with a mean age of 39.3 years (range, 3-77 years). MRI was performed in all the patients. RESULTS In addition to DVAs, cavernomas were present in 30 patients (62.5%), haematomas in 7 (14.5%), gliosis in 6 (12.5%), demyelinating plaques in 4 (8.3%) and a glioblastoma in 1 (2.2%). The mean diameter of the DVAs was 1.1mm and the mean diameter of the lesions was 17.4mm. The susceptibility weighted imaging (SWI) sequence was also applied to 12 patients with cavernomas. The relevant sequence in all of these patients contributed to the diagnosis. CONCLUSION Our study shows that DVAs can accompany a wide spectrum of lesions, especially cavernomas. Although their pathophysiology has not yet been clearly established, these lesions may have a common aetiology.
Collapse
Affiliation(s)
| | - H Ogul
- Duzce University, Duzce, Turkey
| | | |
Collapse
|
17
|
Retta SF, Perrelli A, Trabalzini L, Finetti F. From Genes and Mechanisms to Molecular-Targeted Therapies: The Long Climb to the Cure of Cerebral Cavernous Malformation (CCM) Disease. Methods Mol Biol 2021; 2152:3-25. [PMID: 32524540 DOI: 10.1007/978-1-0716-0640-7_1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cerebral cavernous malformation (CCM) is a rare cerebrovascular disorder of genetic origin consisting of closely clustered, abnormally dilated and leaky capillaries (CCM lesions), which occur predominantly in the central nervous system. CCM lesions can be single or multiple and may result in severe clinical symptoms, including focal neurological deficits, seizures, and intracerebral hemorrhage. Early human genetic studies demonstrated that CCM disease is linked to three chromosomal loci and can be inherited as autosomal dominant condition with incomplete penetrance and highly variable expressivity, eventually leading to the identification of three disease genes, CCM1/KRIT1, CCM2, and CCM3/PDCD10, which encode for structurally unrelated intracellular proteins that lack catalytic domains. Biochemical, molecular, and cellular studies then showed that these proteins are involved in endothelial cell-cell junction and blood-brain barrier stability maintenance through the regulation of major cellular structures and mechanisms, including endothelial cell-cell and cell-matrix adhesion, actin cytoskeleton dynamics, autophagy, and endothelial-to-mesenchymal transition, suggesting that they act as pleiotropic regulators of cellular homeostasis, and opening novel therapeutic perspectives. Indeed, accumulated evidence in cellular and animal models has eventually revealed that the emerged pleiotropic functions of CCM proteins are mainly due to their ability to modulate redox-sensitive pathways and mechanisms involved in adaptive responses to oxidative stress and inflammation, thus contributing to the preservation of cellular homeostasis and stress defenses.In this introductory review, we present a general overview of 20 years of amazing progress in the identification of genetic culprits and molecular mechanisms underlying CCM disease pathogenesis, and the development of targeted therapeutic strategies.
Collapse
Affiliation(s)
- Saverio Francesco Retta
- Department of Clinical and Biological Science, School of Medicine and Surgery, University of Torino, Orbassano (Torino), Italy. .,CCM Italia Research Network, Torino, Italy.
| | - Andrea Perrelli
- Department of Clinical and Biological Science, School of Medicine and Surgery, University of Torino, Orbassano (Torino), Italy.,CCM Italia Research Network, Torino, Italy
| | - Lorenza Trabalzini
- CCM Italia Research Network, Torino, Italy.,Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Federica Finetti
- CCM Italia Research Network, Torino, Italy.,Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| |
Collapse
|
18
|
Hart BL, Mabray MC, Morrison L, Whitehead KJ, Kim H. Systemic and CNS manifestations of inherited cerebrovascular malformations. Clin Imaging 2021; 75:55-66. [PMID: 33493737 DOI: 10.1016/j.clinimag.2021.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 12/25/2022]
Abstract
Cerebrovascular malformations occur in both sporadic and inherited patterns. This paper reviews imaging and clinical features of cerebrovascular malformations with a genetic basis. Genetic diseases such as familial cerebral cavernous malformations and hereditary hemorrhagic telangiectasia often have manifestations in bone, skin, eyes, and visceral organs, which should be recognized. Genetic and molecular mechanisms underlying the inherited disorders are becoming better understood, and treatments are likely to follow. An interaction between the intestinal microbiome and formation of cerebral cavernous malformations has emerged, with possible treatment implications. Two-hit mechanisms are involved in these disorders, and additional triggering mechanisms are part of the development of malformations. Hereditary hemorrhagic telangiectasia encompasses a variety of vascular malformations, with widely varying risks, and a more recently recognized association with cortical malformations. Somatic mutations are implicated in the genesis of some sporadic malformations, which means that discoveries related to inherited disorders may aid treatment of sporadic cases. This paper summarizes the current state of knowledge of these conditions, salient features regarding mechanisms of development, and treatment prospects.
Collapse
Affiliation(s)
- Blaine L Hart
- Department of Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Marc C Mabray
- Department of Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Leslie Morrison
- Department of Neurology, MSC10 5620, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
| | - Kevin J Whitehead
- Division of Cardiovascular Medicine and the Program in Molecular Medicine, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA; George E. Wahlen Salt Lake City VA Medical Center, 500 Foothill Boulevard, Salt Lake City, UT 84148, USA.
| | - Helen Kim
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA.
| |
Collapse
|
19
|
Larson AS, Lanzino G, Brinjikji W. Variations of Intracranial Dural Venous Sinus Diameters from Birth to 20 Years of Age: An MRV-Based Study. AJNR Am J Neuroradiol 2020; 41:2351-2357. [PMID: 33093136 DOI: 10.3174/ajnr.a6816] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/05/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE The role of the dural venous sinus system in cerebrovascular pathology and the understanding of normal developmental patterns and sizes of the dural venous sinus system continue to expand. The purpose of this study was to review MR venograms to elucidate developmental patterns and diameters of the major dural venous sinuses from 0 to 20 years of age. MATERIALS AND METHODS All available MR venograms of patients 0-20 years of age who presented to our institution were retrospectively reviewed. Patient age at the time of image acquisition was noted, and measurements were taken of the diameters of the major dural venous sinuses. The presence of embryonic sinuses including the persistent falcine sinus and the occipital sinus was noted. Dominance patterns of the transverse sinus system were determined. Mean diameters of each sinus were plotted as a function of age. The prevalence of persistent prenatal sinuses and transverse sinus-dominance patterns was compared across ages. RESULTS A total of 429 MR venograms from 429 patients were reviewed. All dural venous sinuses demonstrated a maximal growth rate from 0 to 7 years of age and reached maximal diameters around 5-10 years of age. The prevalence of falcine sinuses and occipital sinuses trended downward across increasing age categories (P = .09 and, <.0001, respectively). CONCLUSIONS Dural venous sinuses demonstrate maximal growth between 0 and 7 years of age and reach adult size around 5-10 years of age. Involution of the prenatal sinuses continues to take place after birth into childhood but is largely absent in early adulthood.
Collapse
Affiliation(s)
- A S Larson
- From the Department of Radiology (A.S.L., G.L., W.B.)
| | - G Lanzino
- From the Department of Radiology (A.S.L., G.L., W.B.)
- Department of Neurosurgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- From the Department of Radiology (A.S.L., G.L., W.B.)
- Department of Neurosurgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
20
|
Brzegowy K, Kowalska N, Solewski B, Musiał A, Kasprzycki T, Herman-Sucharska I, Walocha JA. Prevalence and anatomical characteristics of developmental venous anomalies: an MRI study. Neuroradiology 2020; 63:1001-1008. [PMID: 33230619 DOI: 10.1007/s00234-020-02612-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Developmental venous anomalies (DVAs) are extreme anatomical venous variations formed by multiple radiating medullary veins, which converge centripetally into a single collecting vein. Their coexistence with symptomatic cavernous malformations (CMs) has been reported in the literature. The aim of this study was to assess the characteristics of DVAs using MRI. METHODS A total of 6948 head MRIs of adult Caucasian patients were retrospectively analyzed to determine the number and locations of DVAs. We collected the data on the termination of the collecting vein, the prevalence of DVA-related CMs, and MRI FLAIR signal-hyperintensity corresponding to the location of the DVA. RESULTS At least one DVA was identified in 7.46% of the patients. The prevalence decreased with age, with a Pearson correlation coefficient of - 0.7328. A total of 599 DVAs were identified. Multiple DVAs were found in 10.92% of the patients with DVAs. The DVAs were identified more often in the supratentorial region (73.12%, p < 0.0001), and the most common location was the frontal lobe (35.23%). The collecting vein usually drained into the superficial cerebral veins (68.78%). CMs were observed in 4.14% of the patients with DVAs, and the prevalence showed a positive correlation with age. Signal-intensity abnormalities were identified in the vicinity of 5.18% DVAs. CONCLUSION Knowledge about characteristics of DVAs and associated anomalies is essential for neuroradiologists and neurosurgeons. The large number of currently available diagnostic studies enables us to assess anatomical variants on a great number of subjects.
Collapse
Affiliation(s)
- Karolina Brzegowy
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
| | - Natalia Kowalska
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Bernard Solewski
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agata Musiał
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Kasprzycki
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Izabela Herman-Sucharska
- Department of Radiology, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.,Voxel Diagnostic Medical Center, Krakow, Poland
| | - Jerzy A Walocha
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
21
|
Geraldo AF, Messina SS, Tortora D, Parodi A, Malova M, Morana G, Gandolfo C, D'Amico A, Herkert E, Govaert P, Ramenghi LA, Rossi A, Severino M. Neonatal Developmental Venous Anomalies: Clinicoradiologic Characterization and Follow-Up. AJNR Am J Neuroradiol 2020; 41:2370-2376. [PMID: 33093132 DOI: 10.3174/ajnr.a6829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although developmental venous anomalies have been frequently studied in adults and occasionally in children, data regarding these entities are scarce in neonates. We aimed to characterize clinical and neuroimaging features of neonatal developmental venous anomalies and to evaluate any association between MR imaging abnormalities in their drainage territory and corresponding angioarchitectural features. MATERIALS AND METHODS We reviewed parenchymal abnormalities and angioarchitectural features of 41 neonates with developmental venous anomalies (20 males; mean corrected age, 39.9 weeks) selected through a radiology report text search from 2135 neonates who underwent brain MR imaging between 2008 and 2019. Fetal and longitudinal MR images were also reviewed. Neurologic outcomes were collected. Statistics were performed using χ2, Fisher exact, Mann-Whitney U, or t tests corrected for multiple comparisons. RESULTS Developmental venous anomalies were detected in 1.9% of neonatal scans. These were complicated by parenchymal/ventricular abnormalities in 15/41 cases (36.6%), improving at last follow-up in 8/10 (80%), with normal neurologic outcome in 9/14 (64.2%). Multiple collectors (P = .008) and larger collector caliber (P < .001) were significantly more frequent in complicated developmental venous anomalies. At a patient level, multiplicity (P = .002) was significantly associated with the presence of ≥1 complicated developmental venous anomaly. Retrospective fetal detection was possible in 3/11 subjects (27.2%). CONCLUSIONS One-third of neonatal developmental venous anomalies may be complicated by parenchymal abnormalities, especially with multiple and larger collectors. Neuroimaging and neurologic outcomes were favorable in most cases, suggesting a benign, self-limited nature of these vascular anomalies. A congenital origin could be confirmed in one-quarter of cases with available fetal MR imaging.
Collapse
Affiliation(s)
- A F Geraldo
- From the Neuroradiology Unit (A.F.G.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.,Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - S S Messina
- Radiology Unit (S.S.M.), Casa di Cura Regina Pacis, Palermo, Italy
| | - D Tortora
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - A Parodi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - M Malova
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - G Morana
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - C Gandolfo
- Interventional Unit (C.G.), IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A D'Amico
- Dipartimento di Scienze Biomediche Avanzate (A.D.), Universita' Federico II, Napoli, Italy
| | - E Herkert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - P Govaert
- Division of Neonatology (E.H., P.G.), Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - L A Ramenghi
- Neonatal Intensive Care Unit (A.P., M.M., L.A.R.)
| | - A Rossi
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| | - M Severino
- Neuroradiology Unit (A.F.G., D.T., G.M., A.R., M.S.)
| |
Collapse
|
22
|
Zhang F, Xue Y, Zhang F, Wei X, Zhou Z, Ma Z, Wang X, Shen H, Li Y, Cui X, Liu L. Identification of a Novel CCM1 Frameshift Mutation in a Chinese Han Family With Multiple Cerebral Cavernous Malformations. Front Neurosci 2020; 14:525986. [PMID: 33071727 PMCID: PMC7538688 DOI: 10.3389/fnins.2020.525986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Cerebral cavernous malformations (CCMs) are vascular lesions that predominantly occur in the brain. CCMs can be sporadic or hereditary in an autosomal dominant manner. The genes harboring variants of familial CCMs (FCCMs) include CCM1/KRIT1, CCM2/MGC4607, and CCM3/PDCD10. In this study, we identified a novel CCM1/KRIT1 mutation in a Chinese family with FCCMs. This family consists of 20 members, and 6 of them had been diagnosed with CCMs. The proband patient is a 17-year-old female who has suffered from CCM-related intracranial hemorrhage four times. Magnetic resonance imaging (MRI) revealed four lesions in the different brain regions and one lesion has progressively enlarged. The pathological histology confirmed CCMs. Whole exome sequencing revealed a novel deletion mutation (c.1635delA) within exon 15 of CCM1/KRIT1 gene in the proband patient, her mother, and her uncle who had CCMs. This frameshift mutation led to a premature termination codon (PTC) at nucleotides 1652-1654. We also detected that the CCM1 mRNA levels in the blood lymphocytes of the family members with CCMs were reduced by 46.4% compared to that in healthy controls. Collectively, our results suggested that the CCM1 mutation could potentially be a causative factor for FCCMs in the Chinese family and the reduction of CCM1 mRNA expression in the blood lymphocytes of the patients might be a potential biomarker for the diagnosis and prognosis of CCMs. Our findings expanded the spectrum of CCM mutations and helped to guide genetic counseling and early genetic diagnosis for at-risk family members.
Collapse
Affiliation(s)
- Fan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yiteng Xue
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feng Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoming Wei
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhisong Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhaoru Ma
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaosong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Shen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yujun Li
- Department of Microbiology and Wu Lien-Teh Institute, Harbin Medical University, Harbin, China
| | - Xiaoying Cui
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Li Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
23
|
Flemming KD, Lanzino G. Cerebral Cavernous Malformation: What a Practicing Clinician Should Know. Mayo Clin Proc 2020; 95:2005-2020. [PMID: 32605781 DOI: 10.1016/j.mayocp.2019.11.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/17/2019] [Accepted: 11/13/2019] [Indexed: 01/24/2023]
Abstract
Cavernous malformations (CMs) are angiographically occult, low-flow vascular malformations of the central nervous system. They are acquired lesions, with approximately 80% of patients having the sporadic form and 20% the familial form of the disease. The lesions may also develop years after radiotherapy. At the microscopic level, they consist of endothelium-lined cavities (or "caverns") containing blood of different ages. The endothelium proliferates abnormally, and tight junctions are absent or dysfunctional, resulting in leakiness of the endothelium and clinical manifestations in some patients. Cavernous malformations can be an incidental finding or can present with focal neurologic deficits, seizures, or headache, with or without associated hemorrhage. Management of the CM lesion requires knowledge of the natural history of the disease compared with the risk of surgical intervention. Surgery is often considered for symptomatic patients with lesions in a noneloquent location. Medical management is warranted for symptoms related to the CM. Research aimed at understanding the genes and signaling pathways related to CMs have provided potential drug targets, and clinical trials are underway to determine whether medications reduce the risk of future bleeding without surgery or modify the disease course. In addition, recent epidemiologic data have aided practitioners in determining how to treat comorbid conditions in patients with a potentially hemorrhagic lesion. This review provides an overview of the epidemiology, presentation, and clinical management of CMs.
Collapse
|
24
|
Rabinstein AA, Flemming KD. Cavernous malformations with DVA. Neurology 2020; 95:13-14. [DOI: 10.1212/wnl.0000000000009718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
25
|
Symptomatic developmental venous anomalies. Acta Neurochir (Wien) 2020; 162:1115-1125. [PMID: 31925540 DOI: 10.1007/s00701-020-04213-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Cerebral developmental venous anomalies (DVAs) are variations of venous vascular anatomy related to an underdevelopment of either the superficial or deep venous emissary system, resulting in a dilated transmedullary vein fed by multiple smaller venous radicles responsible for drainage of normal brain parenchyma. While typically benign and found incidentally on imaging studies, DVAs can rarely be symptomatic. The radiographic appearance of DVAs, as well as their symptomatic manifestations, is diverse. Herein, we will discuss the pathophysiology of symptomatic DVAs while providing illustrative case examples depicting each of their pathogenic mechanisms.
Collapse
|
26
|
Minimally Invasive Resection of Intracerebral Amyloidoma: Case Report and Systematic Review of the Literature. World Neurosurg 2020; 138:205-213. [PMID: 32084617 DOI: 10.1016/j.wneu.2020.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Management of cerebral amyloidomas has lacked consensus owing to their rarity. We present a case and review 39 reported cases of amyloidomas in the literature, comparing their initial presentation, imaging characteristics, treatment, and progression. CASE DESCRIPTION A 56-year-old woman presented with a history of intractable headaches and progressive speech difficulty. Imaging demonstrated a 1.7 × 2.6 cm left frontal subcortical hemorrhagic mass with an associated developmental venous anomaly, characteristics initially suggestive of a cavernous malformation. Diffusion tractography imaging was employed to avoid interference with the intact arcuate fasciculus and corticospinal tracts to minimize neurologic deficits. CONCLUSIONS To our knowledge, this is the first documented case of the use of diffusion tractography in preoperative planning for cerebral amyloidoma resection. Our systematic review of 39 reported cases of amyloidomas in the literature provided insight regarding how these rare lesions have manifested and progressed and further understanding of current theories regarding their etiology and pathophysiology. Cerebral amyloidomas are rare, localized, proteinaceous aggregates with variable presentation and prognosis and no apparent relationship to systemic amyloidosis. Biopsy may be useful in determination of progression. Diffusion tractography is a valuable tool for minimizing complications associated with resection.
Collapse
|
27
|
Zafar A, Quadri SA, Farooqui M, Ikram A, Robinson M, Hart BL, Mabray MC, Vigil C, Tang AT, Kahn ML, Yonas H, Lawton MT, Kim H, Morrison L. Familial Cerebral Cavernous Malformations. Stroke 2020; 50:1294-1301. [PMID: 30909834 DOI: 10.1161/strokeaha.118.022314] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Atif Zafar
- From the Departments of Neurology (A.Z., M.F., A.I., M.R., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| | - Syed A Quadri
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (S.A.Q.)
| | - Mudassir Farooqui
- From the Departments of Neurology (A.Z., M.F., A.I., M.R., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| | - Asad Ikram
- From the Departments of Neurology (A.Z., M.F., A.I., M.R., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| | - Myranda Robinson
- From the Departments of Neurology (A.Z., M.F., A.I., M.R., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| | - Blaine L Hart
- Radiology (B.L.H., M.C.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| | - Marc C Mabray
- Radiology (B.L.H., M.C.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| | | | - Alan T Tang
- Department of Medicine and Cardiovascular Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia (A.T.T., M.L.K.)
| | - Mark L Kahn
- Department of Medicine and Cardiovascular Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia (A.T.T., M.L.K.)
| | - Howard Yonas
- Neurosurgery (H.Y.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (M.T.L.)
| | - Helen Kim
- Department of Anesthesia and Perioperative Care and Department of Epidemiology and Biostatistics, University of California San Francisco (H.K.)
| | - Leslie Morrison
- From the Departments of Neurology (A.Z., M.F., A.I., M.R., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque
| |
Collapse
|
28
|
A rupture risk analysis of cerebral cavernous malformation associated with developmental venous anomaly using susceptibility-weighted imaging. Neuroradiology 2019; 62:39-47. [PMID: 31482190 DOI: 10.1007/s00234-019-02274-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To search for the risk factors closely related to cerebral cavernous malformation associated with developmental venous anomaly (CCM-DVA) lesions rupture, laying foundations for the development of reasonable individual treatment plans for patients. METHODS In this retrospective study, we collected CCM-DVA patients who met the inclusion criteria in our outpatient department from 2014 to 2017, MRI scans were performed including susceptibility-weighted imaging (SWI) and contrast-enhanced imaging, characteristics and basic clinical information were collected then statistically analyzed, CCM-DVA lesions were divided into 3 types according to the location and quantitative relationship between CCM and DVA. RESULTS A total number of 319 adult patients were identified with 41.2±11.9 years on average, though univariate and multivariate regression analysis, ruptured presentations were more common in patients with prior hemorrhage (p=0.003), type III CCM-DVA lesions (p=0.001), lesions volume>1 cm3 (p<0.001), infratentorial lesions especially located in midbrain (p=0.019), pontine (p=0.007), medulla (p=0.015). Caplan-Meier curve shows a lower Hemorrhage-free survival rate on patients with type III CCM-DVA lesions (log-rank, p=0.0222), functional area lesions (log-rank, p<0.001), lesions volume>1 cm3 (log-rank, p<0.001), infratentorial lesions (log-rank, p=0.0002). CONCLUSION The classification based on the relationship between CCM and DVA may be meaningful to predict the risk of lesion rupture and CCM lesions next to DVA distal branches showed a higher risk of rupture.
Collapse
|
29
|
Hirokawa Y, Fujimoto A, Ichikawa N, Sato K, Tanaka T, Enoki H, Otsuki Y, Okanishi T. Temporal Lobe Cavernous Malformation Caused Epileptic Amnesic Episodes and Mild Cognitive Impairment. Front Neurol 2019; 10:620. [PMID: 31249550 PMCID: PMC6582224 DOI: 10.3389/fneur.2019.00620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023] Open
Abstract
Neuropathological features in Alzheimer's disease (AD) are amyloid β (Aβ) deposits and neurofibrillary changes. AD is characterized by memory impairment and cognitive dysfunction, with some reports associating these impairments with hyperexcitability caused by Aβ in the medial temporal lobe. Epileptic seizures are known to be common in AD. We encountered a 65-year-old patient with cavernous malformation (CM) in the right temporal lobe who exhibited epileptic amnesia (EA) and AD-like symptoms. Scalp electroencephalography (EEG), including long-term video-EEG, showed no interictal discharges, but intraoperative subdural electrode (SE) recording from the right parahippocampal area showed frequent epileptiform discharges. Neuropathologically, senile plaques were found in the surrounding normal cortex of the CM. Postoperatively, the patient has remained free of EA and AD-like symptoms since total removal of the CM. This is the first surgical case report to confirm temporal lobe hyperexcitability associated with EA and AD-like symptoms.
Collapse
Affiliation(s)
- Yusuke Hirokawa
- Department of Neurosurgery, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tokutaro Tanaka
- Department of Neurosurgery, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei-Hamamatsu General Hospital, Hamamatsu, Japan
| |
Collapse
|
30
|
Scimone C, Donato L, Marino S, Alafaci C, D’Angelo R, Sidoti A. Vis-à-vis: a focus on genetic features of cerebral cavernous malformations and brain arteriovenous malformations pathogenesis. Neurol Sci 2018; 40:243-251. [DOI: 10.1007/s10072-018-3674-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/01/2018] [Indexed: 01/07/2023]
|
31
|
Brinjikji W, Hilditch CA, Tsang AC, Nicholson PJ, Krings T, Agid R. Facial Venous Malformations Are Associated with Cerebral Developmental Venous Anomalies. AJNR Am J Neuroradiol 2018; 39:2103-2107. [PMID: 30237297 DOI: 10.3174/ajnr.a5811] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/06/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE A number of studies have demonstrated the existence of segmental vascular disorders affecting soft tissues of the head and neck along with the intracranial vasculature. The purpose of this study was to determine whether there is an association between cerebral developmental venous anomalies and venous malformations of the face, head, and neck. MATERIALS AND METHODS A consecutive series of patients with head and neck venous malformations who underwent MR imaging of the brain with postcontrast T1- or T2*-weighted imaging were included. Developmental venous anomaly prevalence in this patient population was compared with an age- and sex-matched control group without venous malformations at a ratio of 1:2. All images were interpreted by 2 neuroradiologists. Data were collected on venous malformation location, developmental venous anomaly location, developmental venous anomaly drainage pattern, and metameric location of venous malformations and developmental venous anomalies. Categoric variables were compared using χ2 tests. RESULTS Forty-two patients with venous malformations were included. The mean age was 38.1 ± 11.1 years, and 78.6% of patients were female. The prevalence of developmental venous anomalies in this patient population was 28.6%. The control population of 84 patients had a mean age of 40.0 ± 5.9 years, and 78.6% of patients were female. The prevalence of developmental venous anomalies in this patient population was 9.5% (P = .01). In 83.3% of cases, developmental venous anomalies were ipsilateral to the venous malformation, and in 75% of cases, they involved the same metamere. CONCLUSIONS Our case-control study demonstrated a significant association between brain developmental venous anomalies and superficial venous malformations. These findings suggest that there may be a similar pathophysiologic origin for these 2 entities.
Collapse
Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B.)
- Neurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
- Joint Department of Medical Imaging (W.B., C.A.H., A.C.T., P.J.N., T.K., R.A.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - C A Hilditch
- Joint Department of Medical Imaging (W.B., C.A.H., A.C.T., P.J.N., T.K., R.A.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - A C Tsang
- Joint Department of Medical Imaging (W.B., C.A.H., A.C.T., P.J.N., T.K., R.A.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - P J Nicholson
- Joint Department of Medical Imaging (W.B., C.A.H., A.C.T., P.J.N., T.K., R.A.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - T Krings
- Joint Department of Medical Imaging (W.B., C.A.H., A.C.T., P.J.N., T.K., R.A.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - R Agid
- Joint Department of Medical Imaging (W.B., C.A.H., A.C.T., P.J.N., T.K., R.A.), Toronto Western Hospital, Toronto, Ontario, Canada
| |
Collapse
|
32
|
Maish WN. Developmental venous anomalies and brainstem cavernous malformations: a proposed physiological mechanism for haemorrhage. Neurosurg Rev 2018; 42:663-670. [PMID: 30291476 DOI: 10.1007/s10143-018-1039-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/26/2018] [Indexed: 01/28/2023]
Abstract
The incidental diagnosis of both developmental venous anomalies (DVAs) and cavernous malformations (CMs) in the central nervous system is increasing with improved imaging techniques. While classically silent diseases, these cerebrovascular pathologies can follow an aggressive course, particularly when present in the brainstem. In the last decade, substantial research has focussed on KRIT1-mediated tight junction gene expression and their role in CM development. However, our understanding of the physiologic conditions precipitating symptomatic CM development or CM haemorrhage with and without concomitant DVAs, remains lacking. The only established risk factor for CM haemorrhage is a previous history of haemorrhage, and literature currently reports trauma as the only precipitant for symptomatic events. While plausible, this occurs in a minority, with many patients experiencing occult events. This manuscript presents a hypothesis for symptomatic CM events by first discussing the anatomical pathways for intracranial venous outflow via the internal jugular veins (IJV) and vertebral venous plexus (VVP), then exploring the role of venous flow diversion away from the IJVs under physiologic stress during dynamic postural shift. The resultant increase in intracranial venous pressure can exacerbate normal and pre-existing structural DVA pathologies, with repeated exposure causing symptomatic or CM-inducing events. This pathophysiological model is considered in the context of the role of the autonomic nervous system (ANS) in postural intracranial venous outflow diversion, and how this may increase the risk of DVA or CM events. It is hoped that this hypothesis invokes further investigation into precipitants for DVA or CM events and their sequela and, also, furthers the current knowledge on pathophysiological development of DVAs and CMs.
Collapse
Affiliation(s)
- William N Maish
- Australian National University Medical School, Building 4, The Canberra Hospital, Hospital Road, Garran, ACT, 2605, Australia.
| |
Collapse
|
33
|
Li K, Guo Y, Qu L, Xu B, Xu K, Yu J. Hybrid surgery for an arteriovenous malformation fed by an accessory middle cerebral artery and drained by a developmental venous anomaly: A case report and literature review. Exp Ther Med 2018; 16:1994-2000. [PMID: 30186430 PMCID: PMC6122327 DOI: 10.3892/etm.2018.6372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/21/2018] [Indexed: 11/05/2022] Open
Abstract
An accessory middle cerebral artery (AMCA), which mainly acts in the collateral circulation of the middle cerebral artery (MCA), is a rare anatomic malformation. Similar to other intracranial vessels, cerebrovascular disease can occur in the AMCA. However, the development of an arteriovenous malformation (AVM) in the AMCA is very rare, especially in conjuction with developmental venous anomalies (DVAs). Here, a rare case of an AMCA combined with an AVM and a DVA was reported. The patient was a 47-year-old female with intracranial hemorrhage at symptom onset. CT and MRI showed lesions in the left Sylvian fissure and insula accompanied by hemorrhage. DSA suggested a left AMCA; an AVM of the AMCA was located in the deep Sylvian fissure. The AVM was diffusely developed and drained into the DVA. The operation was performed in a hybrid operating room. The major feeding artery of the AVM, which was derived from the AMCA, was clipped, then the AVM and DVA were subsequently removed. Intraoperative DSA showed that the AVM and DVA were radically removed. A pathological examination confirmed the presence of an AVM. The patient recovered well and was discharged. Therefore, as highlighted in this case report, rare AVMs can be found in AMCAs and can even occur simultaneously with a DVA. Hybrid surgical treatment can be used to remove AVMs and can lead to an improved prognosis.
Collapse
Affiliation(s)
- Kailing Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Limei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW This study aims to review the current epidemiology and clinical management of patients with cavernous malformations (CM). RECENT FINDINGS Hemorrhage is the most feared complication and leads to morbidity in patients with CM. Multiple studies including three meta-analyses have provided useful estimates of hemorrhage risk, but have failed to identify a modifiable risk factor for prevention of cavernous malformation related hemorrhage. In treating the CM itself, surgical risk is weighed against the natural history. However, accumulating knowledge regarding the roles of CCM 1, 2, and 3 genes has led to the discovery of potential therapeutic targets. The risk of future hemorrhage in patients with CM is highest in those who have had previously clinical hemorrhages. Estimated risks are helpful in counseling patients and comparing to the risk of surgery. Future clinical trials of candidate medications are likely to target those patients with prior clinical hemorrhage in whom the surgical risk is deemed high.
Collapse
|