Venous-predominant parenchymal arteriovenous malformation: a rare subtype with a venous drainage pattern mimicking developmental venous anomaly

Abstract

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.

Long-term treatment outcome of venous-predominant arteriovenous malformation

“…Second, no definite nidus was noted. 2,8 Vp-AVM was assessed by 2 factors, the presence of clinical symptoms relevant to vpAVMs and the degree of the AV shunt at angiography. Symptomatic lesions included ICH, seizure, neurological deficits, and relevant clinical symptoms such as headache or dizziness.…”

“…Accordingly, an atypical DVA with early venous drainage did not become symptomatic. On the contrary, Im et al 8 reported that a vp-AVM more closely resembles an AVM because of its histological and clinical similarity. They believed that more aggressive treatment modalities such as resection or Gamma Knife surgery (GKS) can be used to prevent symptomatic vp-AVM or to treat intracranial hemorrhage (ICH) associated with a vp-AVM.…”

“…Follow-up radiological tests were performed with MRI or digital subtraction angiography according to parameters that were reported previously. 8 Hematoma removal, GKS, or conservative treatments were performed. Hematoma removal was indicated for the management of increased intracranial pressure (ICP) refractory to medical treatment.…”

“…Such a vascular lesion can be distinguished from an AVM by the absence of a discrete nidus and poorly identifiable, enlarged feeding arteries, and distinguished from DVAs by the early venous drainage from the arterial or capillary phase. Various terminologies including arterialized DVA, 15 mixed-type vascular malformation, 6 venous angioma with arteriovenous (AV) shunt, 10 atypical DVA with early venous filling, mixed venous and arteriovenous malformations, medullary venous malformation with an arterial component, or venous-predominant AVM (vp-AVM), 8 which is referred to here, have been used to interpret the rare vascular anomalies, but still no definite terminology has been established.…”

“…Such a vascular lesion can be distinguished from an AVM by the absence of a discrete nidus and poorly identifiable, enlarged feeding arteries, and distinguished from DVAs by the early venous drainage from the arterial or capillary phase. Various terminologies including arterialized DVA, 15 mixed-type vascular malformation, 6 venous angioma with arteriovenous (AV) shunt, 10 atypical DVA with early venous filling, mixed venous and arteriovenous malformations, medullary venous malformation with an arterial component, or venous-predominant AVM (vp-AVM), 8 which is referred to here, have been used to interpret the rare vascular anomalies, but still no definite terminology has been established.abbreviatioNs AV = arteriovenous; AVM = arteriovenous malformation; DVA = developmental venous anomaly; GKS = Gamma Knife surgery; ICH = intracranial hemorrhage; vp-AVM = venous-predominant AVM. obJective Treatment strategies for venous-predominant arteriovenous malformation (vp-AVM) remain unclear due to the limited number of cases and a lack of long-term outcomes.…”