Venous-predominant parenchymal arteriovenous malformation: a rare subtype with a venous drainage pattern mimicking developmental venous anomaly.
OBJECTIVE
Considerable confusion exists in the literature regarding the classification of cerebrovascular malformations and their clinical significance. One example is provided by the atypical developmental venous anomaly (DVA) with arteriovenous shunt, because it remains controversial whether these lesions should be classified as DVAs or as atypical cases of other subtypes of cerebrovascular malformations. The purpose of this study was to clarify the classification of these challenging vascular lesions in an effort to suggest an appropriate diagnosis and management strategy.


METHODS
The authors present a series of 15 patients with intracranial vascular malformations that were angiographically classified as atypical DVAs with arteriovenous shunts. This type of vascular malformation shows a fine arterial blush without a distinct nidus and early filling of dilated medullary veins that drain these arterial components during the arterial phase on angiography. Those prominent medullary veins converge toward an enlarged main draining vein, which together form the caput medusae appearance of a typical DVA.


RESULTS
Based on clinical, angiographic, surgical, and histological findings, the authors propose classifying these vascular malformations as a subtype of an arteriovenous malformation (AVM), rather than as a variant of DVA or as a combined vascular malformation.


CONCLUSIONS
Correct recognition of this AVM subtype is required for its proper management, and its clinical behavior appears to follow that of a typical AVM. Gamma Knife radiosurgery appears to be a good alternative to resection, although long-term follow-up results require verification.
Department of Neurosurgery, Dongguk University Hospital, Gyeonggido, Korea.
So-Hyang
SH
Im
Moon Hee
MH
Han
Bae Ju
BJ
Kwon
Jung Yong
JY
Ahn
Cheolkyu
C
Jung
Sung-Hye
SH
Park
Chang Wan
CW
Oh
Dae Hee
DH
Han
D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D002550:Cerebral Veins / Q000002:abnormalities*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome