Venous angiomas

Venous angiomas are currently widely referred to as developmental venous anomalies (DVAs), reflecting the prevailing concept that they represent anomalous, but functional, venous channels within the brain parenchyma. Although DVAs are not infrequently associated with other vascular malformations that harbor hemorrhage risk or can present symptomatically, isolated DVAs themselves appear to be benign lesions with little demonstrable link to hemorrhage, seizures, or headaches. Treatments to remove or occlude DVAs are consequently unnecessary. Furthermore, obliteration of a DVA can be harmful as it can lead to impairment in regional cerebral venous drainage, with the resultant risk of venous congestion, infarction, and hemorrhagic conversion, and the potential for devastating consequences from cerebral edema and mass effect. Consequently, even in the management of associated vascular malformations, it is important to preserve the DVA. In rare cases, DVAs can produce direct compressive symptoms, leading to obstructive hydrocephalus or neurovascular compression. In such cases, cerebrospinal fluid diversion or direct microvascular decompression, respectively, without disruption of the DVA itself is appropriate. In the uncommon setting of spontaneous DVA thrombosis leading to venous infarction, anticoagulation, as recommended for dural and cortical venous thrombosis, is a reasonable consideration. Hemorrhagic presentation from a presumed isolated DVA should prompt careful evaluation for an associated vascular malformation as the true etiology of hemorrhage.