What are symptoms of DVA?

Generally asymptomatic if isolated (typically incidental finding on neuroimaging). Symptoms, if present, are usually secondary to associated lesions or complications, such as hemorrhage, thrombosis, and infarction, usually when associated with other vascular malformations (CCM, AVM). Thhrombosis of the draining vein is an extremely rare complication leading to venous infarction.

INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS

Cerebral venous angioma (DVA)

David Goldemund M.D.
Updated on 24/06/2024, published on 20/09/2023

cerebral venous angioma, also known as Developmental Venous Anomaly (DVA), is a congenital malformation where dilated veins with no abnormal feeding artery (caput medusae sign) converge into a single large abnormal draining vein
DVAs rarely bleed ⇒ if a hemorrhage is present, look for associated cavernous malformation (15-20%), AVM, or a tumor
most commonly, DVAs are localized in the parietal and frontal lobes (up to 64%) and cerebellum (up to 30%)
- supratentorial drainage ⇒ superficial or deep subependymal veins
- infratentorial drainage ⇒ the transverse sinus, the great vein of Galeni, petrous sinus → Anatomy of cerebral veins and sinuses

Venous angioma (Developmental venous anomaly)

Clinical presentation

commonly asymptomatic (usually an incidental finding on neuroimaging)
epileptic seizures
headaches
venous infarction (in case of rare thrombosis of the draining vein)
intracerebral bleeding is rare (0.2-0.4% per year)
- increased risk is associated with occlusion of the draining vein, e.g., due to thrombosis [Agarwal, 2014]
- search for an associated cavernous malformation (cavernoma)

Diagnostic evaluation

Differential diagnosis

sometimes, there is an atypical imaging appearance, which may be confounded by concurrent pathology
dural arteriovenous fistula (DAVF)
arteriovenous malformation (AVM)
dural sinus thrombosis
Sturge-Weber syndrome

DVA may mimic thrombosed cerebral vein (Althobaiti, 2019)

Management

a conservative approach is common for isolated DVA
the draining vein often serves as a drainage for the surrounding unaffected areas
- surgical occlusion or spontaneous thrombosis may lead to venous infarction
if needed, treat concurrent malformations

FAQs

What is Developmental Venous Anomaly (DVA)?

a benign cerebral vascular malformation in which dilated veins converge into a single large draining vein
there is no abnormal feeding artery
adjacent brain parenchyma is normal
DVAs are considered congenital

How is DVA diagnosed?

DVA is primarily diagnosed by MRI or CT angiography
SWI is the preferred MRI sequence to detect venous malformations

What are the symptoms of DVA?

generally asymptomatic (typically incidental finding on neuroimaging)
symptoms, if present, are usually secondary to associated lesions (CCM, AVM)
thrombosis of the draining vein is an extremely rare complication leading to venous infarction

How does DVA differ from an AVM?

AVM has large feeding arteries, tortuous vessels, and abnormal adjacent brain parenchyma that are not observed in DVAs

Can DVA cause seizures?

seizures may occur in the presence of an associated epileptogenic lesion (e.g., cavernoma or dysplasia) or as a result of complications (e.g., venous infarction)

Is treatment necessary?

typically, no intervention is needed unless associated with other vascular malformations (AVM, cavernous malformation) or symptomatic hemorrhage

Can DVA be surgically removed?

surgical intervention is rarely indicated and generally not recommended due to the role DVAs play in venous drainage

What is the prognosis?

excellent, particularly when isolated; there is no increased risk of bleeding in isolated DVAs

Follow-up recommendations?

typically, routine follow-up is not required unless DVA is associated with other vascular anomalies