Fact-sheet: Venous angioma - Developmental venous anomalys


Updated on 08/26/2020 at 1:59 PM

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Definition

The most common intracranial vascular malformation (60%).
Incidental, asymptomatic, and non-evolving finding in the vast majority of cases.
"Extreme" anatomic variant of venous drainage, benign.

Dilated transcerebral veins collected by a common trunk (the collector).
This collector drains healthy brain parenchyma and joins the superficial venous network, the deep venous network, or both.

The preferential location is the white matter near the frontal horn of the lateral ventricle, the second most common site being the vicinity of the 4th ventricle.

Clinical features

  • Incidental, asymptomatic, and non-evolving finding in the vast majority of cases.
  • Rare symptomatic forms (Lasjaunias 2008): Thrombosis of the venous collector: > venous infarction or hemorrhage of an adjacent cavernoma
  • Compressive effect > cranial nerves, hydrocephalus.

CT

  • Spontaneously hyperdense draining vein
  • After contrast administration: dilated intraparenchymal vessels in a "caput medusae" or "inverted umbrella" pattern
  • Dystrophic calcifications
  • Hemorrhage if an adjacent cavernoma is present.

MRI

  • SWI sequence: reference standard for demonstrating venous development
  • FLAIR sequence: venous collector shows low signal (very slow venous flow), venous radicles show high signal.
  • Gadolinium injection: caput medusae and inverted umbrella appearance

Association with other vascular malformations+++:

  • Cavernomas: 13 to 40% of cases
  • Sinus pericranii
  • AVM

Possible changes in the adjacent parenchyma (San Millan Ruiz, Neuroradiology 2007):
> Fairly common: atrophy, calcifications, T2 gradient-echo low signal

Management

  • Treatment if associated with a symptomatic cavernoma