gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Associated venous anomalies in cerebral cavernous malformations – A susceptibility-weighted imaging study with a 7T MRI

Meeting Abstract

  • P. Dammann - Department of Neurosugery, University Hospital Essen, Germany
  • T. Gasser - Department of Neurosugery, University Hospital Essen, Germany
  • M.E. Ladd - Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany
  • M. Schlamann - Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
  • E.I. Sandalcioglu - Department of Neurosugery, University Hospital Essen, Germany
  • U. Sure - Department of Neurosugery, University Hospital Essen, Germany

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.09.04

DOI: 10.3205/11dgnc061, URN: urn:nbn:de:0183-11dgnc0610

Published: April 28, 2011

© 2011 Dammann et al.
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Outline

Text

Objective: The incidence of venous anomalies accompanying sporadic cerebral cavernous malformations (CCM) and their role in the pathogenesis of these lesions is still discussed controversially. Furthermore, no clear consensus exists on how to treat this potential epiphenomenon. As imaging of CCM and associated venous structures with conventional MRI techniques or angiography is limited, the basic venous angioarchitecture of these lesions has not yet been studied in detail. With the prospects of high field strength MRI susceptibility-weighted imaging (SWI) for depicting even the smallest venous structures in vivo, more information about these features should be achievable.

Methods: 20 patients with symptomatic or asymptomatic CCM diagnosed with 1.5 T MRI were additionally scanned using a 7T MRI scanner (Magnetom 7T, Siemens Healthcare, Erlangen, Germany) equipped with a gradient coil (125 cm length) capable of 45 mT/m maximum amplitude and a slew rate of 220 mT/m/ms. Sequence parameters for SWI were the following: TE: 15 sec, TR: 27 sec, in-plane resolution 250 µm, slice thickness 1 mm, flip angle 14°. Image data were analysed regarding presence and formation of the CCM-associated venous vessel structures. When possible, a correlation with intraoperative findings was given.

Results: In the 20 patients (19 - 68y, mean age: 43y), a solitary or multiple venous drainage was found in all lesions. In 9 patients the lesion was located in the brainstem, in 11 patients the lesion was located supratentorially. The main draining vein was dilated (1.5 - 2.5 mm) in most of the cases (14/20), draining into superficial or deep cerebral veins. A typical caput medusae with the lesion located near the peripheral branches was found only in 2 cases (Figure 1A [Fig. 1]). In the other cases, the form of the venous structures was more variable (Figure 1B-D [Fig. 1]). A classification of these formations is proposed.

Conclusions: Contrary to former angiographic studies, a significant venous drainage was found in all CCMs within this small study. Atypical venous vessel structures accompanied all CCMs; however, the typical formation of a classical DVA as defined earlier was found in only 2 cases. In the other cases, venous structures showed a more individual appearance. Our findings support former operative reports of venous anomalies accompanying CCMs in 100% of the cases.