Nasal Venous Malformation with Intracranial Communication: Presentation, Management, and Review of the Literature

This manuscript reports the rare case of a pediatric patient with a nasal venous malformation (VM) with intracranial communication and bilateral internal jugular vein (IJV) occlusion. Due to the IJV occlusion, the nasal VM provided collateral circulation for blood drainage from the patient's brain. Spontaneous recanalization of the IJVs was reported in the patient, potentially allowing for new treatment modalities, as the nasal VM would be responsible for less collateral venous outflow. A literature review was conducted to identify the incidence of spontaneous recanalization of the jugular venous system. Through 3 databases, 413 peer-reviewed journal articles were obtained for the systematic review. After eliminating duplicate articles and screening titles, abstracts, and full texts, 4 articles were included in the final literature review. The level of evidence from the literature review was relatively low. All 4 articles identified in the literature review were case reports of spontaneous recanalization of thrombotic events. In our patient, spontaneous recanalization of IJV occlusion allowed for consideration of treatment options (ie, surgical excision) of a nasal VM, which otherwise provided critical venous drainage for the patient's brain. If flow through the IJVs is not sufficient, balloon angioplasty, patch angioplasty, or possible reconstruction of the IJVs may be necessary to allow for treatment of the nasal VM. If these surgical interventions prove to be too high-risk for the patient, conservative therapy may be the best option.