Venous Angioma – A brief Look

Spina Bifida

Cerebral venous angioma is also known as developmental venous anomaly (DVA) and is technically a congenital malformation of veins that drain through the brain. What this means simply is that the person is born with this type of malformation. After the advent of cross-sectional imagining techniques like the MRI and CT, it has been found that these cerebral vascular malformations account for about 50-55% of all such lesions. Their appearance in the brain vasculature has been described euphemistically as a palm tree or a medusa head as these spider-webs of tiny vessels drain into a single larger collecting vein.

These benign vein formations have been known to occur in different parts of the body, but the most common location is the brain or the spinal cord. It’s been estimated that these largely silent venous anomalies occur in as many as 1 in every 50 people and aren’t really dangerous on their own. Even though venous angiomas are malformed anomalies, they are fully integrated with the body’s circulation system and play a useful function in providing the brain with normal drainage and as such, shouldn’t be excised or radiated; doing so could result in venous infarction or even death.

In very rare cases, they have been associated with intracranial hemorrhage, seizures and progressive neurological deficits; they are usually found as incidental findings during imaging studies of patients presenting with headaches or other neurological disorders. Venous angiomas are usually symptomless and most patients aren’t even aware they have them. In many cases, their presence is uncovered only during autopsies.

Generally, these developmental venous anomalies do not require any treatment as they are part and parcel of the brains normal blood circulation, and any surgical excision or closure would result in complications. As they aren’t dangerous, long-term follow-up or imaging isn’t necessary either.

Although the neurosurgical community has classified venous angiomas as being benign lesions, there are growing concerns that this anomaly may be involved in other lesions such as cerebral cavernous malformations and arteriovenous malformations (AVM). This has become obvious as it’s been observed that about 40% of the cavernous angiomas, which are also blood vessel malformations, develop within the close vicinity of venous angiomas. This close association makes surgery difficult as venous angiomas shouldn’t be disturbed while removing cavernous angiomas; and the problem becomes worse when there is more than one cavernous angioma within the vicinity of the venous angioma. Cavernous angiomas or hemangiomas are benign tumors that are known to hemorrhage or leak blood into the surrounding tissue leading to a variety of symptoms that require treatment.

It’s the treatment of these cavernous angiomas that can prove to be a challenge for the neurosurgeon as he attempts to keep the venous angioma safe and intact for normal blood circulation within the brain.

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