The association of venous developmental anomalies and cavernous malformations: pathophysiological, diagnostic, and surgical considerations (original) (raw)

2006, Neurosurgical FOCUS

NTRACRANIAL vascular malformations were originally classified by McCormick 31 into four types: discrete venous, arteriovenous, capillary, and CMs, each with distinct pathological criteria for definition. The range of imaging characteristics and clinical manifestations that generally differentiate them have been characterized in several studies. Recently, mixed or transitional vascular malformations with pathological features of more than one type of malformation within the same lesion have been described. The detection of a wide spectrum of intermediate forms of McCormick's original categories suggests that these lesions might be a continuum of progression of a single pathological process. Investigators have described the simultaneous occurrence of venous malformations and CMs, arteriovenous and venous malformations, CMs with arteriovenous or capillary components, 25,34,47 and capillary telangiectasias associated with venous malformations. In addition, authors have described venous malformations associated with both a CM and a capillary telangiectasia. The coexistence of a CM and a DVA is the most common mixed vascular malformation. The natural history of this mixed phenotype is unclear, making it difficult to determine a long-term prognosis for symptomatic and asymptomatic patients. Moreover, much controversy exists about the biological behavior and the management of the DVAs associated with the CM. Even though most authors agree that microsurgical resection of the CM alone provides protection against future bleeding, 35-37,40 some reports raise the question whether the abnormal draining vein is the actual area of disease that induces the blood flow disturbances, which in turn result in the formation of a CM (de novo and recurrent). Developmental venous anomalies (DVAs) are often associated with intracranial cavernous malformations (CMs). The frequency of this association and the observation of de novo CMs located near a known, preexisting DVA raise speculations as to the possible etiopathogenetic relationship between the two. In this article, the authors review the recent literature dealing with the potential etiopathogenetic, prognostic, and therapeutic implications of the association between DVAs and CMs.