Surgical Approach for Patients Combined with Cavernoma and Developmental Venous Anomaly

Between May 2000 and August 2009, we had 5 cases combined with cavernoma and developmental venous anomaly (DVA). In 3 of 5 cases, we removed the cavernoma. Because DVA plays a role in normal venous return, we must preserve the DVA during resection of the cavernoma. We report some surgical considerations to avoid injury of the DVA. In Case 1, a 40-year-old female presented with headache. Magnetic resonance imaging (MRI) showed a cavernoma in the parieto-occipital lobe. We selected a high parietal approach using a navigation system to confirm the location of the cavernoma and DVA. In Case 2, a 70-year-old female presented with cerebellar hemorrhage. MRI showed a cavernoma in the left cerebellopontine angle and DVA at the tentorial surface of the left cerebellar hemisphere. Using the lateral infratentorial supracerebellar approach, the DVA was confirmed and then the cavernoma was removed. In Case 3, a 31-year-old female presented with intracerebral hemorrhage. MRI showed 2 cavernomas in the left frontal lobe. We removed a hemorrhagic lesion by the interhemispheric approach with the horizontal head position. In all 3 cases, the cavernoma was totally removed and the DVA was preserved.