6/30/2023 0 Comments Developmental venous anomalyDevelopmental venous anomalies (DVA): the so-called venous angioma. Thalamic venous angiomas draining into a vein of Galen varix. Cerebral venous development in relation to developmental venous anomalies and Vein of Galen aneurysmal malformations. As the hemorrhage risk of DVA is very low (the retrospective risk is 0.22% per year, and the prospective risk is 0.68% per year ), and an inappropriate surgical or interventional therapy may cause a horrible consequence, conservative treatment is recommended for patients with endurable clinical symptoms. The key point in the differential diagnosis of vein of Galen varix from a true vein of Galen aneurysmal malformation (VGAM) was the absence of arteriovenous malformation (AVM) or arteriovenous fistula (AVF).Īs this special system drained the normal cerebral parenchyma, these changes are considered to be a “venous anomaly” and not a “venous malformation”. To compensate for the increased pressure of the venous system, the falcine sinus did not close, and another straight sinus occurred, as well as a vein of Galen varix and a dilated duro-venous system. In this case, stenosis of the inferior straight sinus is considered to be the reason for vein of Galen varix. In the cases without collecting vein stenosis, venous hypertension may also exist because of volume overload as the result of histopathological changes in the vessel wall, including wall thickening and hyalinization. However, as an increasing number of cases are currently being described, “venous hypertension” is becoming the new cause of these types of anomalies. Venous varix, as Lasjaunias described in the 1980s, “does not exist without an obstruction in the cerebral venous system, and the location varies from the proximal straight sinus to the jugular foramen”. All these patients were managed conservatively. Two of them combined with cerebral hemiatrophy of the anomalous hemisphere, which was considered to be caused by longstanding venous congestion and which was not found in our patient. Two of them presented with an enlargement of the vein of Galen, but none presented with involvement of the vein of Galen varix or a falcine sinus as in the current patient. The clinical symptoms include dizziness (1 case), headache (1 case) and epilepsy (2 cases). To our knowledge, there are only 4 reported cases of an entire hemispheric DVA, such as in this case (Table 1). DVAs of the brain range from a small draining vein, involving a small portion of the brain, to a large hemispheric venous anomaly, and the latter is extremely rare. The imaging features and differential diagnosis of DVAs were previously described. It consists of a radial complex of venous radicles, named “caput medusae” in angiographies, and a dilated collecting vein, which drains the normal cerebral parenchyma. As her symptom was only nonspecific mild dizziness probably caused by head trauma with no evidence of hydrocephalus, intracranial mass effect or thrombosis, we decided to monitor her in the outpatient setting instead of an urgent intervention, and her clinical status was stable for 1 year.ĭevelopmental venous anomaly, first suggested by Lasjaunias in 1986, used to be known as “venous angioma” or “cerebral venous malformation”. There was no evidence of AVM or AVF in the DSA of this patient, which was judged to favor a final diagnosis of hemispheric DVA draining into a vein of Galen varix rather than a typical vein of Galen aneurysmal malformation (VGAM). Part of the superior and inferior sagittal sinuses, torcular herophili, and left transverse sinus were dilated (Fig. The left Labbe’s vein was also affected and dilated and drained into the left transverse sinus. The inferior sinus seemed to be severely stenotic. The vein of Galen varix converged with the inferior sagittal sinus and then entered into a falcine sinus as well as two straight sinuses. Part of the DVA was draining into the bilateral internal cerebral veins (ICVs), which made the veins mildly dilated. The majority of the DVA was draining into a dilated vein of Galen via a varicose collecting vein. The venous phase of the left carotid artery showed a deep-type large DVA draining the entire left hemisphere. The arterial phase of both right and left carotid artery and vertebral arteriograms were normal. The patient underwent digital subtraction angiography (DSA) soon after she came to our department, and the result was noteworthy.
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