DVA Related Perilesional Venous Morphology and Histopathological Thrombus Burden in Cerebral Cavernous Malformations

The relationship between developmental venous anomalies (DVAs) and associated cerebral cavernous malformations (CCMs) remains incompletely understood, particularly regarding perilesional venous morphology and intralesional thrombus burden. This study investigated the association between MRI-visible DVA-related perilesional venous morphology and histopathological thrombus burden in CCMs.

This exploratory retrospective study included 42 patients who underwent surgical resection of CCMs between 2020 and 2023. Total cross-sectional area (TCSA) of MRI-visible DVA-related perilesional veins was calculated as the sum of circular areas derived from individual vessel diameters. Thrombus burden was graded on hematoxylin and eosin-stained sections as grade 0 (<30%), grade 1 (30%-60%), or grade 2 (>60%). In 38 patients with an identifiable DVA, associations were evaluated using Spearman correlation and proportional-odds ordinal logistic regression, with a parsimonious model adjusted for lesion size.

TCSA was inversely correlated with thrombus burden (Spearman ρ = -0.38, p = 0.020). The odds ratio for a higher thrombus grade per 1 mm² increase in TCSA was 0.81 (95% CI 0.67-0.97; p = 0.025) and 0.81 after adjustment for lesion size (95% CI 0.67-0.98; p = 0.030). After exclusion of the patient with the largest TCSA, the size-adjusted estimate remained inverse but its confidence interval included 1 (OR 0.82, 95% CI 0.66-1.01; p = 0.066).

Greater MRI-visible perilesional venous TCSA was associated with lower histopathological thrombus grade in this selected surgical cohort. The estimate was sensitive to exclusion of the largest observation. These exploratory findings do not establish venous drainage capacity, a hemodynamic mechanism, or causality.