Purpose: The aim of this paper is to analyse the pathophysiology of 3 DVA cases from our institution, review the literature and propose a classification of these lesions. Materials & Methods: The pathophysiology of DVAs were analysed with CT perfusion (CTP), 4 dimensional dynamic computed tomography angiography (4D CTA) and catheter digital subtraction angiography. Results: Symptomatic DVAs may be caused by associated lesions and compression of neural structures by the DVAs. The imbalance between the inflow and outflow of these lesions, including venous ischaemia, has also been postulated as a cause. Our analysis showed that increased cerebral blood flow (CBF) and cerebral blood volume (CBV) and decreased mean transit time (MTT) and time to peak (TTP) were found in DVAs with micro arteriovenous shunting. DVAs without shunting had raised MTT and TTP instead. Conclusion: We postulate that the arteriovenous shunting resulted in arterial steal and chronic hypoxia which could be a pathophysiological mechanism for symptomatic DVAs. CTP and 4D CTA are effective non invasive tools to study DVAs. A classification is proposed.
AbeTSingerRJMarksMP. Coexistence of occult vascular malformations and developmental venous anomalies in the central nervous system: MR evaluation. Am J Neuroradiol. 1998; 19: 51–57.
2.
SarwarMMcCormickWF. Intracerebral venous angioma. Case report and review. Arch Neurol. 1978; 35: 323–325.
KuMGRheeDYParkHS. Repeated Intracerebral Hemorrhage from Developmental Venous Anomaly Alone. J Korean Neurosurg Soc.2009 Jan; 45 (1): 46–49.
5.
OkuderaTOhtaTHuangYP. Developmental and radiological anatomy of the superficial cerebral convexity vessels in the human fetus. J Neuroradiol. 1988; 15: 205–224.
6.
GallioneCJPasykKABoonLM. A gene for familial venous malformations maps to chromosome 9p in a second large kindred. J Med Genet. 1995; 32: 197–199.
7.
BoonLMMullikenJBVikkulaM. Assignment of a locus for dominantly inherited venous malformations to chromosome 9p. Hum Mol Genet. 1994; 3: 1583–1587.
8.
ValavanisAWellauerJYasargilMG. The radiological diagnosis of cerebral venous angioma: cerebral angiography and computed tomography. Neuroradiology. 1983; 24: 193–199.
AbdulraufSIKaynarMYAwadIA: A comparison of the clinical profile of cavernous malformations with and without associated venous malformations. Neurosurgery. 1999; 44: 1–46; discussion 46–47.
11.
JungJHKimMHParkHK: Cerebral cavernous hemangiomas associated with venous angiomas. J Korean Neurosurg Soc.1996; 25: 662–667.
12.
KocKAnikIAkanselQ: Massive intracerebral hemorrhage due to developmental venous anomaly. Br J eurosurg. 2007: 21: 403–405.
13.
McLaughlinMRKondziolkaDFlickingerJC: The prospective natural history of cerebral venous malformations. Neurosurgery. 1998; 43: 195–200; discussion 200–201.
KellerKFlackeSUrbachH: Diffusion- and perfusion-weighted magnetic resonance imaging in deep cerebral venous thrombosis. Stroke. 1999; 30: 1144–1146.
22.
MakkatSStadnikTPeetersE: Pathogenesis of venous stroke: evaluation with diffusion- and perfusion-weighted MRI. J Stroke Cerebrovasc Dis.2003; 12 (3): 132–6.
23.
LagaresAMillánJMRamosA: Perfusion computed Tomography in a dural arteriovenous fistula presenting with focal signs: Vascular congestion as a cause of reversible neurologic dysfunction. Neurosurgery. 2010; doi: 10.1227/01.NEU.0000361996.27921.6C.
24.
LasjauniasPLLandrieuPRodeschG: Cerebral proliferative angiopathy: Clinical and angiographic description of an entity different from cerebral AVMs. Stroke. 2008; 39: 878–885.
MeyerBSchallerCFrenkelC. Physiological steal around AVMs of the brain is not equivalent to cortical ischemia. Neurol Res.1998; 20 (Suppl 1): 13–7.
27.
DehkharghaniSDillonWPBryantSO. Unilateral calcification of the caudate and putamen: Association with underlying developmental venous anomaly. Am. J. Neuroradiol. 2010; doi:10.3174/ajnr.A2199.
28.
MatsudaHTeradaTKatohM. Brain perfusion SPECT in a patient with a subtle venous angioma. Clin Nucl Med.1994; 19: 785–8.
29.
ImSHHanMHKwonBJ. Venous-predominant parenchymal arteriovenous malformation: a rare subtype with a venous drainage pattern mimicking developmental venous anomaly. J Neurosurg. 2008; 108: 1142–7.
30.
RodeschG: Can the concept of benign developmental venous anomaly (the “So Called Venous Angioma”) be revisited. Presented at the IX WFITN Congress in Beijing, 2007.
31.
AgazziSRegliLUskeA. Developmental venous anomaly with an arteriovenous shunt and a thrombotic complication. Case report. J Neurosurg. 2001; 94 (3): 533–7.
