Venous malformations, and

Observational studies Sclerotherapy with 3% sodium tetradecyl sulfate has been studied in 13 patients with venous malformations and microcystic lymphatic malformations, all low-flow malformations extending into the subcutis, confirmed... 

Vascular malformations of the brain are usually divided into arteriovenous malformations, capillary telangiectasias, venous malformations, and cavernous malformations. However, for a long time, the term angiographically occult vascular malformation or cryptic (Cohen et al. 1982 Dillon 1997 Wilson 1992) has been used to describe those vascular malformations that could not be visualized angiographically, but obviously were able to cause intracerebral hemorrhage. 

Lymphatic malformations (LMs), like other vascular malformations, are commonly present at birth with a predilection for the head, neck and axilla (Fig. 1.9). They affect both sexes equally. They are less common than venous malformations and are usually subcutaneous [1,5,68]. 

Maffucci s syndrome consists in the association of venous malformations and multiple enchondro-mas. Intraosseous venous malformations as well as enchondromas are responsible for the bony defects [12]. 

The reported outcome of endovascular treatment of venous malformation has been extremely variable from one series to another. No series has been reported based upon strict MRI documentation and sufficient follow-up. No predictors of success have been clearly outlined. Overall, it appears that favourable results may depend on the extension of the venous malformations and the number of sclerotherapy sessions. Recurrence due to recanalization of treated venous malformations is more likely in cases of diffuse involvement with associated coagulopathy [13]. 

Venous malformations consist of collections of venous channels and a large draining vein. Most are asymptomatic but they may present with hemorrhage into the ventricles, or seizures. On contrast CT, the draining vein may appear as a linear enhancing streak, but a flow void on MRl is more sensitive. The definitive diagnosis is made on the venous phase of a cerebral angiogram. 

The main clinical indications for imaging the cerebral circulation are TIA (e.g. to identify arterial stenosis), acute ischemic stroke (e.g. to identify vessel occlusion), intracerebral hemorrhage (e.g. to identify an underlying vascular malformation) and possible arterial dissection, flbromuscular dysplasia or other arteriopathies, cerebral aneurysm, intracranial venous thrombosis or cerebral vasculitis. 

Venous malformation CNS spinal leptomeninges Veins and gliotic or normal brain tissue no arteries... 

Legiehn, G. M. Heran, M. K. S. (2008) Venous malformations classification, development, diagnosis, and interventional radiologic management. Radiologic... 

Injection volume and concentration of sclerosant depend on the size of the lesion and the flow rate. Some authors used it as sclerosing foam hy mixing sclerosant and C02 or air [117,118] (see also Sect. 2.2.2.5.2). The German manufacture of polidocanol recommends a maximum daily dose of 2 mg/ kg [117]. Some authors described that the maximum recommended dose in the treatment of varicose veins is 6 ml of 3% polidocanol [118], This agent is associated with less severe allergic and inflammatory reactions [119]. Skin necrosis is rare. However, Cabrera reported skin necrosis in 6% of cases with venous malformations. One reversible cardiac arrest was reported [121]. 

O Donovan JC, Donaldson JS, Morello FP, et al. (1997) Symptomatic hemangiomas and venous malformations in infants, children, and young adults treatment with percutaneous injection of sodium tetradecyl sulfate. AJR Am J Roentgenol 169 723-729... 

Konez O, Burrows PE, Mulliken JB (2002) Cervicofacial venous malformations MRI features and interventional strategies. Interv Neuroradiol 8 227-234... 

In conclusion, patients with head and neck venous malformations obviously have an increased probability of having a DVA and an increased chance of having multiple DVAs. There are no data on whether the risk of having cavernomas is also increased in this patient subgroup. 

Boukobza et al. (1996) found a specific pattern of DVAs in patients with extensive venous malformations of the head and neck. The draining veins were more tortuous and dilated and more often draining into the deep venous system. Additionally, the incidence of DVA seems to be increased in patients with slow-flow vascular malformations of the head... 

Abdulrauf SI, Kaynar MY, Awad lA (1999) A comparison of the clinical profile of cavernous malformations with and without associated venous malformations. Neurosurgery 44 41-46, discussion 46-47... 

Clatterbuck RE, Elmaci 1, Rigamonti D (2001) The juxtaposition of a capillary teleangiectasia, cavernous malformation, and developmental venous anomaly in the brainstem of a single patient case report. Neurosurgery 49 1246-1250... 

Sarwar M, McCormick WF (1978) Intracerebral venous angioma. Case report and review. Arch Neurol 35 323-325 Seiz M, Brockmann MA, Schneider UC, Woitzik J, Scharf J (2007) Combination of a supratentorial venous anomaly and infratentorial developmental venous anomalies mimicking AV-malformation a case report. Zentralbl Neurochir.68(4) 217-219... 

Abe T, Singer RJ, Marks MP, Norbash AM, Crowley RS, Steinberg GK (1998) Coexistence of occult vascular malformations and developmental venous anomalies in the central nervous system MR evaluation. AJNR Am J Neuroradiol... 

Houdart E, Gobin YP, Casasco A, Aymard A, Herbreteau D, Merland JJ (1993) A proposed angiographic classification of intracranial arterio-venous fistulae and malformations. Neuroradioly 35 381-385... 

Karlsson B, Lax I, Soderman M et al. (1996) Prediction of results following Gamma-Knife surgery for brain stem and other centrally located arterio-venous malformations relation to natural course. Stereotact Funct Neurosurg 66(Suppl l) 260-268... 

Vinuela F (1992) Functional evaluation and embolization of intracranial arterio-venous malformations. In Vinuela F, Van Halbach V, Dion J (eds) Interventional neuroradiology, endovascular therapy of the central nervous system. Raven, New York, pp 77-86... 

Yamamoto M, Jimbo M, Ide M et al. (1992) Long-term followup of radiosurgically treated arterio-venous malformations in children. Surg Neurol 38 95-100 Yamamoto Y, Coffey RJ, Nichols DA et al. (1995) Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time and technical factors on obliteration rate. J Neurosurg 83 832-837... 

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