Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery

Introduction: Developmental venous anomalies (DVAs) are considered variants of normal transmedullary veins. Their association with cavernous malformations is reported to increase the risk of hemorrhage. Expert consensus recommends meticulous planning with MR imaging, use of anatomical "safe...

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Autores: Agyemang, Kevin, Gómez Rodríguez, Rony, Rocha Marussi, Victor Hugo, Marte Arias, Sally Allinson, Vilcahuaman Paitań, Alexander Feliciano, Campos Filho, José Maria, Chaddad-Neto, Feres
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/59330
Acceso en línea:http://hdl.handle.net/10230/59330
http://dx.doi.org/10.3389/fneur.2023.1073366
Access Level:acceso abierto
Palabra clave:Brainstem
Case report
Cavernous angioma
Cavernous malformation
Developmental venous anomaly
Spontaneous occlusion
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spelling Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgeryAgyemang, KevinGómez Rodríguez, RonyRocha Marussi, Victor HugoMarte Arias, Sally AllinsonVilcahuaman Paitań, Alexander FelicianoCampos Filho, José MariaChaddad-Neto, FeresBrainstemCase reportCavernous angiomaCavernous malformationDevelopmental venous anomalySpontaneous occlusionIntroduction: Developmental venous anomalies (DVAs) are considered variants of normal transmedullary veins. Their association with cavernous malformations is reported to increase the risk of hemorrhage. Expert consensus recommends meticulous planning with MR imaging, use of anatomical "safe zones", intraoperative monitoring of long tracts and cranial nerve nuclei, and preservation of the DVA as key to avoiding complications in brainstem cavernoma microsurgery. Symptomatic outflow restriction of DVA is rare, with the few reported cases in the literature restricted to DVAs in the supratentorial compartment. Case: We present a case report of the resection of a pontine cavernoma complicated by delayed outflow obstruction of the associated DVA. A female patient in her 20's presented with progressive left-sided hemisensory disturbance and mild hemiparesis. MRI revealed two pontine cavernomas associated with interconnected DVA and hematoma. The symptomatic cavernoma was resected via the infrafacial corridor. Despite the preservation of the DVA, the patient developed delayed deterioration secondary to venous hemorrhagic infarction. We discuss the imaging and surgical anatomy pertinent to brainstem cavernoma surgery, as well as the literature exploring the management of symptomatic infratentorial DVA occlusion. Conclusion: Delayed symptomatic pontine venous congestive edema is extremely rare following cavernoma surgery. DVA outflow restriction from a post-operative cavity, intraoperative manipulation, and intrinsic hypercoagulability from COVID-10 infection are potential pathophysiological factors. Improved knowledge of DVAs, brainstem venous anatomy, and "safe entry zones" will further elucidate the etiology of and the efficacious treatment for this complication.Frontiers202420242023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/59330http://dx.doi.org/10.3389/fneur.2023.1073366reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésFront Neurol. 2023 Mar 14;14:1073366© 2023 Agyemang, Gómez Rodríguez, Rocha Marussi, Marte Arias, Feliciano Vilcahuaman Paitań, Campos Filho and Chaddad-Neto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (http://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/593302026-06-12T07:21:37Z
dc.title.none.fl_str_mv Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
title Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
spellingShingle Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
Agyemang, Kevin
Brainstem
Case report
Cavernous angioma
Cavernous malformation
Developmental venous anomaly
Spontaneous occlusion
title_short Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
title_full Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
title_fullStr Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
title_full_unstemmed Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
title_sort Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
dc.creator.none.fl_str_mv Agyemang, Kevin
Gómez Rodríguez, Rony
Rocha Marussi, Victor Hugo
Marte Arias, Sally Allinson
Vilcahuaman Paitań, Alexander Feliciano
Campos Filho, José Maria
Chaddad-Neto, Feres
author Agyemang, Kevin
author_facet Agyemang, Kevin
Gómez Rodríguez, Rony
Rocha Marussi, Victor Hugo
Marte Arias, Sally Allinson
Vilcahuaman Paitań, Alexander Feliciano
Campos Filho, José Maria
Chaddad-Neto, Feres
author_role author
author2 Gómez Rodríguez, Rony
Rocha Marussi, Victor Hugo
Marte Arias, Sally Allinson
Vilcahuaman Paitań, Alexander Feliciano
Campos Filho, José Maria
Chaddad-Neto, Feres
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Brainstem
Case report
Cavernous angioma
Cavernous malformation
Developmental venous anomaly
Spontaneous occlusion
topic Brainstem
Case report
Cavernous angioma
Cavernous malformation
Developmental venous anomaly
Spontaneous occlusion
description Introduction: Developmental venous anomalies (DVAs) are considered variants of normal transmedullary veins. Their association with cavernous malformations is reported to increase the risk of hemorrhage. Expert consensus recommends meticulous planning with MR imaging, use of anatomical "safe zones", intraoperative monitoring of long tracts and cranial nerve nuclei, and preservation of the DVA as key to avoiding complications in brainstem cavernoma microsurgery. Symptomatic outflow restriction of DVA is rare, with the few reported cases in the literature restricted to DVAs in the supratentorial compartment. Case: We present a case report of the resection of a pontine cavernoma complicated by delayed outflow obstruction of the associated DVA. A female patient in her 20's presented with progressive left-sided hemisensory disturbance and mild hemiparesis. MRI revealed two pontine cavernomas associated with interconnected DVA and hematoma. The symptomatic cavernoma was resected via the infrafacial corridor. Despite the preservation of the DVA, the patient developed delayed deterioration secondary to venous hemorrhagic infarction. We discuss the imaging and surgical anatomy pertinent to brainstem cavernoma surgery, as well as the literature exploring the management of symptomatic infratentorial DVA occlusion. Conclusion: Delayed symptomatic pontine venous congestive edema is extremely rare following cavernoma surgery. DVA outflow restriction from a post-operative cavity, intraoperative manipulation, and intrinsic hypercoagulability from COVID-10 infection are potential pathophysiological factors. Improved knowledge of DVAs, brainstem venous anatomy, and "safe entry zones" will further elucidate the etiology of and the efficacious treatment for this complication.
publishDate 2023
dc.date.none.fl_str_mv 2023
2024
2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/59330
http://dx.doi.org/10.3389/fneur.2023.1073366
url http://hdl.handle.net/10230/59330
http://dx.doi.org/10.3389/fneur.2023.1073366
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Front Neurol. 2023 Mar 14;14:1073366
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Frontiers
publisher.none.fl_str_mv Frontiers
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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