Venous Angioma Through Pons

pontine dva

This patient presented with a TIA-like episode, and due to abnormal posterior fossa venous appearance went on to have a CT venogram. This demonstrates two developmental venous anomalies - one large one coursing though the pons.

Also know as venous angioma, a DVA is a congenital malformation of veins which drain normal brain. It is characterised by a Medusa head of veins draining into a single larger collecting vein, which in turn drains into either a dural sinus or into a deep ependymal vein. The appearance has also been likened to a palm tree. Usually these lesions are solitary, except in blue rubber bleb naevus syndrome, but are common, seen in 2.5 - 10% of autopsy specimens.

The two most common locations are:

  1. frontal lobe draining towards the frontal horn of the lateral ventricle (example here)
  2. cerebellar hemisphere draining towards the fourth ventricle (example here)

If isolated, then no treatment is necessary. If part of an mixed venous malformation then treatment will be predicated by the other component. Informing the surgeon of the presence of a DVA is however essential as cautery of the the collecting vein can lead to venous infarction.

For more information on DVAs please visit Radiopaedia.org here.

Reference: Diagnostic Neuroradiology by A. Osborn

Credit: Dr Frank Gaillard