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The Case for Conservative Management of Venous Angiomas

Published online by Cambridge University Press:  18 September 2015

Douglas Kondziolka ,
Peter K. Dempsey  and
L. Dade Lunsford
Douglas Kondziolka
Affiliation:
Department of Neurological Surgery, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh
Peter K. Dempsey
Affiliation:
Department of Neurological Surgery, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh
L. Dade Lunsford*
Affiliation:
Department of Neurological Surgery, Presbyterian-University Hospital, University of Pittsburgh, Pittsburgh
*
Professor of Neurological Surgery, University of Pittsburgh School of Medicine, Room 9402, Presbyterian-University Hospital, Pittsburgh, Pennsylvania, USA 15213
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Abstract:

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Venous angiomas (developmental venous anomalies) are vascular malformations increasingly recognized in general neurosurgical or neurological practice. They are associated with intracranial hemorrhage, seizures, or progressive neurological deficits or found as incidental findings in patients who present with headaches or have neuroimaging studies for investigation of unrelated neurological disorders. Since venous angiomas drain normal cerebral tissue within a functionally normal arterial territory, resection can lead to venous infarction. This report studies 27 patients with venous angiomas, all of whom had conservative treatment. The venous angioma was considered to be responsible for the onset of neurological symptoms in 14 patients (7 with hemorrhage, 3 with hemorrhage and seizures, 2 with seizures, one with an extrapyramidal movement disorder, and one with motor deficit). Thirteen patients had incidental lesions (8 with headache, and 5 with unrelated neurological symptoms). Ten venous angiomas were in the posterior fossa; seven in the cerebellum. Location did not correlate with symptomatic presentation. No patient with hemorrhage required surgical evacuation of the hematoma. No patient died or had significant morbidity during the follow-up interval (mean of 3.7 years). Venous angiomas are low flow, low resistance vascular malformations, many of which are not associated with neurological sequelae. Our series supports the concept that surgical removal or radiosurgical obliteration should not be performed unless a patient has a second life threatening hemorrhage.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 18 , Issue 3 , August 1991 , pp. 295 - 299
Copyright
Copyright © Canadian Neurological Sciences Federation 1991

References

REFERENCES

1.Lobato, RD, Perez, C, Rivas, JJ, et al. Clinical, radiological, and pathological spectrum of angiographically occult intracrania vascular malformations. J Neurosurg 1988; 68:518–531.CrossRefGoogle Scholar
2.Fierstien, SB, Pribram, HW, Hieshima, G. Angiography and computed tomography in the evaluation of cerebral venous malformations. Neuroradiology 1979; 17:137–148.CrossRefGoogle ScholarPubMed
3.Nishizaki, T, Tamaki, N, Matsumoto, S, et al. Consideration of the operative indications for posterior fossa venous angiomas. Surg Neurol 1986; 25: 441–445.CrossRefGoogle ScholarPubMed
4.Courville, CB. Morphology of small vascular malformations of the brain, with particular reference to the mechanism of their drainage. J Neuropathol Exp Neurol 1963; 22: 272–284.CrossRefGoogle Scholar
5.Goulao, A, Alvarez, H, Garcia Monaco, R, et al. Venous anomalies and abnormalities of the posterior fossa. Neuroradiology 1990; 31: 476–482.CrossRefGoogle ScholarPubMed
6.McCormick, WF, Hardman, JM, Boulter, TR. Vascular malformations ("angiomas") of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 1968; 28: 241–251.CrossRefGoogle ScholarPubMed
7.Cabanes, J, Blasco, R, Garcia, M, et al. Cerebral venous angiomas. Surg Neurol 1979; 11: 385–389.Google ScholarPubMed
8.Hacker, DA, Latchaw, RE, Chou, SN, et al. Bilateral cerebellar venous angioma. J Comput Assist Tomogr 1981; 5: 424–426.CrossRefGoogle ScholarPubMed
9.Malik, GM, Morgan, JK, Boulos, RS, et al. Venous angiomas: An underestimated cause of intracranial hemorrhage. Surg Neurol 1988; 30: 350–358.CrossRefGoogle ScholarPubMed
10.Matsushima, T, Rhoton, AL, De Oliveira, E, et al. Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 1983; 59: 63–105.CrossRefGoogle ScholarPubMed
11.Moritake, K, Handa, H, Mori, K, et al. Venous angiomas of the brain. Surg Neurol 1980; 14: 95–105.Google ScholarPubMed
12.Numaguchi, Y, Kitamura, K, Fukui, M, et al. Intracranial venous angiomas. Surg Neurol 1982; 18: 193–202.CrossRefGoogle ScholarPubMed
13.Pak, H, Patel, SC, Malik, GM, et al. Successful evacuation of a pontine hematoma secondary to rupture of venous angiomas. Surg Neurol 1980; 15: 164–167.CrossRefGoogle Scholar
14.Sadeh, M, Shacked, I, Rappaport, ZH, et al. SSurgical extirpation of a venous angioma of the medulla oblongata simulating multiple selerosis. Surg Neurol 1982; 17: 334–337.CrossRefGoogle Scholar
15.Biller, J, Toffol, GJ, Shea, JF, et al. Cerebellar venous angiomas; a continuing controversy. Arch Neurol 1985; 42: 367–370.CrossRefGoogle ScholarPubMed
16.Lasjaunias, P, Burrows, P, Planet, C. Developmental venous anomalies (DVA): The so-called venous angioma. Neurosurg Rev 1986; 9: 233–244.CrossRefGoogle ScholarPubMed
17.Rothfus, WE, Albright, AL, Casey, KF, et al. Cerebellar venous angioma: "benign" entity?. Am J Neuroradiol 1984; 5: 61–66.Google ScholarPubMed
18.Senegor, M, Dohrmann, GJ, Wollmann, RL. Venous angiomas of the posterior fossa should be considered as anomalous venous drainage. Surg Neurol 1983; 19: 26–32.CrossRefGoogle ScholarPubMed
19.Olson, E, Gilmore, RL, WRichmond, B. Cerebral venous angiomas. Radiology 1984; 151: 97–104.CrossRefGoogle ScholarPubMed
20.Imakita, S, Nishimura, T, et al. Cerebral vascular malformation. Applications of magnetic resonance imaging to differential diagnosis. Neuroradiology 1989; 31: 320–325.CrossRefGoogle ScholarPubMed
21.Rigamonti, S, Spetzler, RF,Drayer, BP, et al. Appearance of venous malformations on magnetic resonance imaging. J Neurosurg 1988; 69: 535–539.CrossRefGoogle ScholarPubMed
22.Saito, Y, Kobayashi, N. Radiology. J Neurosurg 1981; 139: 87–94.Google Scholar
23.Noran, HH. Intracranial vascular tumors and malformations. Arch Pathol 1945; 39: 393–416.Google Scholar
24.Preissig, RS, Preissig, SH,Drayer, JA. Angiographic demonstration of a cerebral venous angioma. J Neurosurg 1976; 44: 628–631.CrossRefGoogle ScholarPubMed
25.Pardatscher, K, Fiore, DL,Galligioni, F, et al. Diagnosis of cerebral venous angioma by rapidly enhanced CT scan. Surg Neurol 1980; 14: 111–113.Google ScholarPubMed
26.Agnoli, AL, Hildebrandt, G. Cerebral venous angiomas. Acta Neurochir 1985; 78: 4–12.CrossRefGoogle ScholarPubMed
27.Sarwar, M, McCormick, WF. Intracerebral venous angioma. Arch Neurol 1978; 35: 323–325.CrossRefGoogle ScholarPubMed
28.Handa, H, Moritake, K.Venous angioma of the brain In: Fein, JM, Flamm, ES, (editor). Cerebrovascular Surgery, Volume 4. New York: Springer Verlag 1985; 1139–1149.CrossRefGoogle Scholar
29.Kondziolka, D, Lunsford, LD,Coffey, RJ, et al. Stereotactic radiosurgery for angiographically occult vascular malformations: Indications and preliminary experience. Neurosurgery 1990; 27: 892–900.CrossRefGoogle ScholarPubMed