Deep Venous Anomalies Research Articles

Pediatric Cerebral Cavernous Malformation: A Single-Centered Experience of 23 Cases.

To describe, and to evaluate the clinical and radiological characteristics of pediatric cavernous malformations (CMs) and the surgical approaches and their outcomes in a single center. We retrospectively reviewed pediatric patients with CMs that were treated in our center between 2010 and 2020. Radiological, clinical, and demographic features, as well as treatment details were evaluated. Of 23 patients, 12 were male, and 11 were female. Two patients with multiple CMs had a family history. The most common symptoms were headaches (9/23, 39.1%) and seizures (9/23, 39.1%). Twenty patients had single lesions and three patients had multiple lesions. According to Zabramski classification, eight (34.7%) patients had type 1, 11 (47.8%) had type 2 and four (17.3%) had type 3 lesions. Thirteen patients had recurrent preoperative hemorrhages and nine had increased lesion size. Seven patients (30.4%) had coexisting deep venous anomalies in the CM vicinity. Twenty-one patients underwent microsurgical resection (5/23 simple lesionectomy, 16/23 lesionectomy + resection of the surrounding hemosiderin ring). All lesions were completely resected. No surgical mortalities or major complications occurred. Since pediatric CMs are more aggressive than adult CMs, they should not be underestimated. Microsurgical total resection should be the first treatment choice where possible. We concluded that early surgical treatment and resection of perilesional hemosiderin-stained tissue, when feasible, yield the most favorable results at long-term follow-up including seizure outcomes.

Quantitative Apparent Diffusion Coefficient Mapping May Predict Seizure Onset in Children With Sturge-Weber Syndrome

BackgroundSturge-Weber syndrome (SWS) is often accompanied by seizures, stroke-like episodes, hemiparesis, and visual field deficits. This study aimed to identify early pathophysiologic changes that exist before the development of clinical symptoms and to evaluate if the apparent diffusion coefficient (ADC) map is a candidate early biomarker of seizure risk in patients with SWS. MethodsThis is a prospective cross-sectional study using quantitative ADC analysis to predict onset of epilepsy. Inclusion criteria were presence of the port wine birthmark, brain MRI with abnormal leptomeningeal capillary malformation (LCM) and enlarged deep medullary veins, and absence of seizures or other neurological symptoms. We used our recently developed normative, age-specific ADC atlases to quantitatively identify ADC abnormalities, and correlated presymptomatic ADC abnormalities with risks for seizures. ResultsWe identified eight patients (three girls) with SWS, age range of 40 days to nine months. One patient had predominantly LCM, deep venous anomaly, and normal ADC values. This patient did not develop seizures. The remaining seven patients had large regions of abnormal ADC values, and all developed seizures; one of seven patients had late onset seizures. ConclusionsLarger regions of decreased ADC values in the affected hemisphere, quantitatively identified by comparison with age-matched normative ADC atlases, are common in young children with SWS and were associated with later onset of seizures in this small study. Our findings suggest that quantitative ADC maps may identify patients at high risk of seizures in SWS, but larger prospective studies are needed to determine sensitivity and specificity.

AB104. The deep venous lesions in the patients who suffered varicocele

ObjectiveTo reveal the deep venous lesions in the patients who suffered varicocele.MethodsSince the bilateral varicocele patients who had undergone the varicocele surgery often presented a dissatisfactory outcome. Meanwhile, some patients with unilateral varicocele relapsed after the surgery. So, the two kinds of patients were collected in this research. The method to reveal deep venous lesions is direct computed tomography venography (DCTV).ResultsThe bilateral varicocele patients had a relatively high rate of discovered deep venous anomaly by DCTV. And the relapsed patients received surgery could be found lack of collateral circulation of internal iliac vein and spermatic cord vein.ConclusionsThe deep venous lesions should be considered before any kind of spermatic cord vein ligation. The bilateral varicocele and relapse patients underwent ligation were suggested to do DCTV exam.

Reversible increases in cortical diffusion-weighted MR signal in a patient with Sturge–Weber syndrome and subacute hemiplegia

A 30-year-old man with Sturge–Weber syndrome (SWS) diagnosed 10 years previously was admitted with a 3 day history of headache, photophobia, drowsiness and progressive left hemiplegia. There was a history of a similar episode in 2004, complicated by a period of generalised tonic–clonic status epilepticus. He had remained seizurefree for some years on levetiracetam 500 mg bd. Examination revealed a port-wine stain in a right trigeminal V1 distribution. He was drowsy and partially oriented, with left lower facial weakness. There was complete left hemiplegia with brisk left-sided deep tendon reflexes, left extensor plantar response and left-sided sensory extinction. There was no acute haemorrhage or infarct on CT brain. CSF white cell count and protein were normal. A T1weighted MRI brain showed dilatation of the deep venous system (Fig. 1a) and pial enhancement following gadolinium, with normal opacification of the superficial venous sinuses (Fig. 1b). There was high diffusion-weighted imaging (DWI) signal limited to the right cerebral cortex (Fig. 1c). EEG showed right-sided slowing but no epileptiform activity. He was treated with aspirin 300 mg/day and tinzaparin 17,000 u/day. Levetiracetam was increased to 1,000 mg bd. The left hemiplegia completely resolved over the next 10 days, and no seizures were observed. He complained of intermittent non-threatening formed visual hallucinations which gradually resolved. Repeat MR showed a resolution in the cortical DWI signal (Fig. 1d). Recurrent stroke-like episodes due to ischaemia or seizures occur frequently in children with SWS [3, 4, 9], but are less well-described in adults. Headaches, mostly with migrainous features, are common and have been associated with stroke-like episodes in one study [6]. Post-ictal Todd’s paresis was also considered as a potential cause of the patient’s symptoms, but the absence of definite seizures and the progressive nature of the deficit were against this, although levetiracetam was increased as a precaution against further deterioration [2]. The deep venous anomalies and pial enhancement we describe are consistent with longstanding vascular changes in SWS [2, 9]. The increased DWI signal over the right cerebral cortex likely represents cortical ischaemia due to microcirculatory stasis within the aberrant leptomeningeal vasculature, a mechanism which has been proposed for neurological complications of SWS [3, 9]. Acute hemiparesis due to chronic venous sinus occlusion is reported in SWS, albeit without DWI changes suggestive of ischaemia [5]. A recent report described increased cortical DWI signal in a patient with SWS with a subacute history of headache and hemiparesis [7], although the DWI changes only occurred after a series of prolonged seizures. Increases in cortical DWI signal have been reported in patients with SWS and chronic neurological deficit, and may reflect gliotic changes in this context [1]. Aspirin is thought to reduce the risk of stroke-like episodes due to microcirculatory stasis [8], and its use in adults with SWS is described anecdotally [7] although there are no large clinical trials to support its use. Given the imaging changes suggestive of C. Kobylecki (&) M. Jones A. Gerhard Department of Neurology, Greater Manchester Neurosciences Centre, Stott Lane, Salford M6 8HD, UK e-mail: christopher.kobylecki@manchester.ac.uk

Klippel-Trenaunay Syndrome and Left Iliac Vein Agenesis

This case report describes a patient with Klippel-Trenaunay syndrome (KTS) and a rare deep venous anomaly, agenesis of the left iliac veins. A dilated suprapubic vein was confirmed by duplex ultrasound assessment and by phlebography to be draining his left lower limb into his right iliac veins. The management options and implications are discussed.

Posterolateral Thigh Perforator Varicosities in 12 Patients

OBJECTIVES To determine whether in patients with posterolateral thigh perforator (PLTP) varicosities ultrasound-guided sclerotherapy (USGS) is successful and to determine any deep venous anomaly. PATIENTS Twelve consecutive patients with PLTP varicosities were investigated and treated. DESIGN In this prospective intervention study USGS of the PLTP with polidocanol microfoam 1–2% was performed with a maximal number of three treatments. Clinical pictures and Duplex imaging were performed before and after treatment. Ascending phlebography was performed in 9 patients. RESULTS Ten patients showed a marked success, defined as no PLTP varicosities visible and no reflux detectable. In 2 patients there was moderate success. The mean number of treatments was 1.58, the mean diameter of the PLTP vein was reduced from 4.06 (range, 2.2–6.1) to 1.97 (range, 0–3.3) mm (p=0.003, Wilcoxon signed rank test). No serious side effects were noted. No deep venous anomaly was found in the phlebographic study. CONCLUSION In patients with PLTP varicosities, USGS is very successful, with very few side effects. No deep venous anomalies were found in our study, which conforms to the literature.

Posterolateral Thigh Perforator Varicosities in 12 Patients: A Normal Deep Venous System and Successful Treatment with Ultrasound-Guided Sclerotherapy

To determine whether in patients with posterolateral thigh perforator (PLTP) varicosities ultrasound-guided sclerotherapy (USGS) is successful and to determine any deep venous anomaly. Twelve consecutive patients with PLTP varicosities were investigated and treated. In this prospective intervention study USGS of the PLTP with polidocanol microfoam 1-2% was performed with a maximal number of three treatments. Clinical pictures and Duplex imaging were performed before and after treatment. Ascending phlebography was performed in 9 patients. Ten patients showed a marked success, defined as no PLTP varicosities visible and no reflux detectable. In 2 patients there was moderate success. The mean number of treatments was 1.58, the mean diameter of the PLTP vein was reduced from 4.06 (range, 2.2-6.1) to 1.97 (range, 0-3.3) mm (p=0.003, Wilcoxon signed rank test). No serious side effects were noted. No deep venous anomaly was found in the phlebographic study. In patients with PLTP varicosities, USGS is very successful, with very few side effects. No deep venous anomalies were found in our study, which conforms to the literature.

Prevalence of deep venous anomalies in congenital vascular malformations of venous predominance

Purpose: The overall incidence of congenital vascular malformations in the general population is 1.5%. Approximately two thirds of them are malformations of venous predominance. Abnormalities of the deep venous trunks have been observed in association with large superficial compensatory varices in these type of malformations. Knowledge of the integrity of the deep venous system is important in their management because excision of the enlarged superficial veins may be deleterious if there is aplasia or hypoplasia of the deep venous trunks. The objective was to investigate the prevalence and nature of deep venous anomalies that occur in patients with congenital vascular malformations of venous predominance both in our series and in the series from the medical literature.Methods: From the last 35 years of medical literature, we reviewed seven series of congenital vascular malformations that provided pertinent information on the subject of our study. We also reviewed our own series of 392 patients with congenital vascular malformations studied at Children's Hospital of Mexico City (1963–1983; n = 223 children) and at Walter Reed Army and National Naval Medical Centers (1984–1998; n = 169 children). Of 392 patients, 257 (65.5%) had malformations of venous predominance; these were the subject of our analysis. Prevalence of the following deep venous anomalies was recorded: phlebectasia, aplasia or hypoplasia of venous trunks, aneurysms, and avalvulia. Diagnosis was made by one or more of the following methods: Doppler scanning, duplex scanning, plethysmography, computerized tomography, magnetic resonance imaging, and angiography.Results: At least one anomaly of the deep venous system was present in 47% of the congenital vascular malformations of venous predominance reviewed. Phlebectasia was recorded in 36% of the cases, and aplasia or hypoplasia of deep venous trunks was observed in 8% of the cases. Venous aneurysms also were present in 8% of the cases; avalvulia was recorded in 7% of the cases.Conclusion: Anomalies of the deep venous system occur in almost one half of congenital vascular malformations of venous predominance. The most common is the relatively innocuous phlebectasias that occur in over one third of cases. Aplasia/hypoplasia, venous aneurysms, and avalvulia were less frequent, each less than 10%; but failure to detect the latter three anomalies may lead to serious therapeutic errors.

Prevalence of deep venous anomalies in congenital vascular malformations of venous predominance

The overall incidence of congenital vascular malformations in the general population is 1.5%. Approximately two thirds of them are malformations of venous predominance. Abnormalities of the deep venous trunks have been observed in association with large superficial compensatory varices in these type of malformations. Knowledge of the integrity of the deep venous system is important in their management because excision of the enlarged superficial veins may be deleterious if there is aplasia or hypoplasia of the deep venous trunks. The objective was to investigate the prevalence and nature of deep venous anomalies that occur in patients with congenital vascular malformations of venous predominance both in our series and in the series from the medical literature. From the last 35 years of medical literature, we reviewed seven series of congenital vascular malformations that provided pertinent information on the subject of our study. We also reviewed our own series of 392 patients with congenital vascular malformations studied at Children's Hospital of Mexico City (1963-1983; n = 223 children) and at Walter Reed Army and National Naval Medical Centers (1984-1998; n = 169 children). Of 392 patients, 257 (65.5%) had malformations of venous predominance; these were the subject of our analysis. Prevalence of the following deep venous anomalies was recorded: phlebectasia, aplasia or hypoplasia of venous trunks, aneurysms, and avalvulia. Diagnosis was made by one or more of the following methods: Doppler scanning, duplex scanning, plethysmography, computerized tomography, magnetic resonance imaging, and angiography. At least one anomaly of the deep venous system was present in 47% of the congenital vascular malformations of venous predominance reviewed. Phlebectasia was recorded in 36% of the cases, and aplasia or hypoplasia of deep venous trunks was observed in 8% of the cases. Venous aneurysms also were present in 8% of the cases; avalvulia was recorded in 7% of the cases. Anomalies of the deep venous system occur in almost one half of congenital vascular malformations of venous predominance. The most common is the relatively innocuous phlebectasias that occur in over one third of cases. Aplasia/hypoplasia, venous aneurysms, and avalvulia were less frequent, each less than 10%; but failure to detect the latter three anomalies may lead to serious therapeutic errors.