J Korean Neurosurg Soc.  2018 Jul;61(4):485-493. 10.3340/jkns.2018.0089.

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

• Kim HS
• Park SC
• Ha EJ
• Cho WS
• Kim SK
• Kim JE

• KMID: 2417325
• DOI: http://doi.org/10.3340/jkns.2018.0089

Abstract

OBJECTIVE
Cerebral 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.
METHODS
From 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.
RESULTS
The 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.
CONCLUSION
Nonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.

Keyword

Central nervous system venous angioma; Central nervous system vascular malformations

MeSH Terms

Ambulatory Care Facilities
Brain Stem Infarctions
Central Nervous System Vascular Malformations
Central Nervous System Venous Angioma
Cerebral Veins
Follow-Up Studies
Humans
Retrospective Studies
Sinus Pericranii
Varicose Veins*
Veins

Figure

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  Fig. 1. Magnetic resonance imaging and left internal carotid artery angiography of patient 6 showed thrombosed posterior SSS and bilateral transverse sigmoid sinuses. Black arrows show CVs; two are saccular and one is fusiform. SSS : superior sagittal sinus.

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  Fig. 2. Non-contrast magnetic resonance imaging, coronal and sagittal views, and left internal carotid artery angiography of patient 20. An isolated cerebral varix of fusiform type (black arrows) was identied.

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  Fig. 3. Left internal carotid artery angiography of patient 11 whose CV was discovered incidentally. A large developmental venous anomalie was noted, draining medullary veins (black arrowheadeds) and a large saccular type CV was seen (black arrows). CV : cerebral varix.

Reference

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