Cerebral Varix Simulating a Meningioma: Use of 3D Magnetic Resonance Venography for Diagnosis

Tanju, Sumru; Üstüner, Evren; Deda, Haluk; Erden, İlhan

doi:10.1067/j.cpradiol.2006.07.005

Cited by 6 publications

(8 citation statements)

References 7 publications

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“…Two patients (13%) had hemorrhage, and another two (13%) had thrombosis at presentation [ 11 , 12 , 23 , 33 ]. Headache was reported in four patients (26%) [ 6 , 8 , 30 , 31 ]. Seven cases (47%) were discovered incidentally.…”

Section: Resultsmentioning

confidence: 99%

Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

Kim

Park

et al. 2018

J Korean Neurosurg Soc

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ObjectiveCerebral varices (CVs) without an arteriovenous shunt, so called nonfistulous CVs, are very rare, and their etiology and natural course are not well understood. The aim of this study is to evaluate the clinical outcomes of nonfistulous CVs by the analysis of 39 cases. MethodsFrom 2000 to 2015, 22 patients with 39 nonfistulous CVs (≥5 mm) were found by searching the medical and radiologic records of our institute. Clinical data and radiological data including numbers, sizes and locations of CVs and associated anomalies were retrospectively collected and analyzed. Previously reported cases in literature were reviewed as well. ResultsThe mean age of the patients was 21 years (range, 0–78 years). On average, 1.8±1.2 CVs were found per patient. CVs were categorized as either fusiform or saccular depending on their shapes. Two patients had saccular type CVs, seventeen patients had fusiform types, and three patients had both fusiform and saccular CVs. Eight patients had associated compromise of the vein of Galen and the straight sinus. Four of those patients had sinus pericranii, as well. Five patients had CVs that were distal draining veins of large developmental venous anomalies. One patient had associated migration anomaly, and two patients had Sturge- Weber syndrome. Six patients with an isolated cerebral varix were observed. Of the 39 CVs in 22 patients, 20 lesions in 14 patients were followed up in outpatient clinics with imaging studies. The average follow-up duration was 6.6 years. During this period, no neurological events occurred, and all the lesions were managed conservatively. ConclusionNonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.

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Section: Resultsmentioning

confidence: 99%

Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

Kim

Park

et al. 2018

J Korean Neurosurg Soc

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“…They are similar in several aspects, including the MR signal intensity, enhancement characteristics, and even the “dura tail sign,” which easily lead to imaging misdiagnosis. [ 16 ] Two features may be helpful in differential diagnosis. One of the features is the detection of focal erosion of the skull on CT images, which seems to be a helpful pattern to distinguish the varix from a meningioma that usually goes with skull hypertrophy.…”

Section: Discussionmentioning

confidence: 99%

“…Some clinicians recommended close outpatient observation and regular follow-up. [ 9 , 16 ] Reasons could be the balance between slight clinical manifestation and the high risk of craniotomy under general anesthesia. However, during outpatient observation period, hemorrhage, thrombosis, and seizures may develop, which may be potentially life threatening.…”

Section: Discussionmentioning

confidence: 99%

Extra-axial isolated cerebral varix misdiagnosed as convexity meningioma

Tan

Zhou²,

Cui³

et al. 2016

Medicine

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Isolated cerebral varix is a rare cerebrovascular anomaly, which is easily misdiagnosed as other brain tumors.A 59-year-old female patient with noncontributory medical history presented with headache and insomnia for the last 2 months. Upon admission, her neurological examination was unremarkable. Magnetic resonance imaging revealed a well-demarcated extra medullary mass, 11 × 11 mm in size, within the subdural space at the right frontal lobe. The lesion was initially interpreted as a convexity meningioma. After conducting a craniotomy on the patient, an extra-axial varix was exposed and resected subsequently. The patient's headache was resolved soon after surgery and charged without neurologic sequelae.Extra-axial isolated cerebral varix is mimicking convexity meningioma on MR images and should be considered as a differential diagnosis. The focal erosion in the inner table of the skull could be an important character of extra-axial isolated cerebral varix. An extremely round shape and smooth contour of the lesion was another important character. Isolated cerebral varix is rare vascular lesion that is treated surgically in the case of rupture or compression of adjacent structures. The information obtained with noninvasive imaging techniques should include CTA to make a clinical decision.

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“…In most of the reported cases, isolated cerebral varices are subclinical entities discovered incidentally. [ 1 3 5 7 10 11 ] On those rare occasions in which they produce symptoms, they are usually associated with hemorrhage due to rupture, thrombosis, or mass effect on neighboring structures. [ 9 12 ] There is currently not enough information in the literature to determine the risk of rupture and bleeding in isolated cerebral varices.…”

Section: Discussionmentioning

confidence: 99%

“…When the varix has contact with the skull, it causes bone remodeling, which allows ruling out the differential diagnosis of meningioma, which would cause hyperostosis in the adjacent bone. [ 10 11 15 ] On MRIs, cerebral varices are described as extra-axial, cystic, and well-circumscribed lesions. Occasionally, they have been reported as intraaxial lesions, which can lead them to be mistaken with bleeding cystic tumors or thrombosed vascular malformations.…”

Section: Discussionmentioning

confidence: 99%

Isolated giant cerebral varix - A diagnostic and therapeutic challenge: A case report

et al. 2016

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Background:Isolated giant cerebral varix (IGV) is an uncommon vascular lesion that represents a diagnostic challenge and requires dynamic vascular studies for its characterization. The IGV is considered a benign, low-flow venous lesion with very low risk of bleeding that might cause secondary symptoms mainly due to compression of the adjacent parenchyma.Case Description:A 12-year-old female patient with non-contributory medical history presented with headache for the last 2 months. Upon admission, her neurological examination was unremarkable. Magnetic resonance imaging (MRI) and computed tomography angiography (CTA) images demonstrated a large varicose dilation of the superficial Sylvian vein, located anterior to the left temporal pole, with no evidence of abnormal arteriovenous connections or tumoral lesions. This finding was considered incidental and unrelated to her symptoms. In this case, we considered that the combination of CTA and MRIs was enough to establish an accurate diagnosis, excluding the need to perform invasive imaging studies. Taking into account these considerations, the patient was managed with conservative treatment and has been followed up for 1 year, remaining asymptomatic.Conclusion:Cerebral IGVs are rare vascular lesions that are treated conservatively when asymptomatic and surgically in the case of rupture or compression of adjacent structures. Given our observation of a high unlikelihood of vascular connections to arteries, and the information obtained with non-invasive imaging techniques such as CTA and MRI was enough to make a clinical decision and avoid the evaluation with invasive procedures.

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Cerebral Varix Simulating a Meningioma: Use of 3D Magnetic Resonance Venography for Diagnosis

Cited by 6 publications

References 7 publications

Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

Extra-axial isolated cerebral varix misdiagnosed as convexity meningioma

Isolated giant cerebral varix - A diagnostic and therapeutic challenge: A case report

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