Concepts and controversies in the management of cerebral developmental venous anomalies.

d evelopmental venous anomaly is a widely used synonym for venous angioma or cerebral venous malformation [1]. DVAs are the most frequently encountered cerebral vascular malformation and are frequently reported as incidental findings in computed tomography and magnetic resonance imaging studies. Radiological and autopsy series have demonstrated that DVAs occur in 2.5 to 3% of the general population and constitute approximately 60% of all vascular malformations of the central nervous system [2-4]. These purely venous malformations are considered extreme anatomic variations of the normal transmedullary cerebral vasculature that is necessary for the drainage of white and gray matter. DVAs are classified as a type of cerebral vascular malformation, along with arteriovenous malformations, cavernous malformations, and capillary telangiectasias [5]. However, some intracranial vascular lesions fall outside of this classification and have been dubbed “mixed” vascular malformations since they possess features of more than one type of classic vascular malformation [6]. DVAs are encountered in both the pediatric and adult populations, with a slight predominance in males [7,8]. DVAs are usually asymptomatic and follow a benign clinical course in the great majority of cases [9-12]. Classical DVAs have no proliferative potential and no direct arteriovenous shunts [2,13]. Although brain parenchyma drained by a DVA has historically been considered to be normal, recent reports have found abnormalities in a significant proportion of patients [8].