Case 2 - Developmental Venous Anomaly

This is a postcon T1 image. It has a "medusa head" appearance of enhancing branching pattern in left frontal lobe. This represents dilated veins in a Developmental Venous Anomaly (DVA). You do not biopsy it.

1. DVA - aka venous vascular malformation or venous angioma
2. Congenital venous anatomical variant in venous drainage of brain.
3. 2% of population and is the most common venous malformation
4. Incidental and don't cause symptoms
5. If symptoms - likely due to a cavernoma which are sometimes seen in conjunction with DVA
6. No surgery as can cause venous infarct
7. 15-30% are associated with another vascular malformation (cavernoma, AVM, capillary telangiectasia) - the most common is a cavernoma
8. Complications - hemorrhage (likely from associated cavernoma), thrombosis of venous malfomation (which leads to venous infarct and can lead to hemorrhage), seizures (mentioned in literature but not much literature to support claim)
9. DVA - fine network of enlarged medullary venules that join to form central venous flow tract that drains to superficial or deep venous system
10. Thought to occur as alternative when normal drainage is not present.
11. CT - not seen on noncon; contrasted CT - large vascular structure in brain parenchyma w/ smaller radiating veins and the large vascular structure draining to superficial or deep venous system
12. MRI - best seen on postcon images - spoke wheel or caput medusa of venules to larger vein that will drain to deep or superficial venous system; intervening brain parenchyma is normal; draining vein usually has straight course
13. If draining vein is near lateral ventricle - usually drains to subependymal vein which is often enlarged
14. Look for other vascular malformations - MRI preferred method

Reference - emedicine.com