Superficial middle cerebral vein connection to the cavernous sinus is not infrequent in brain arteriovenous malformations: an argument against their congenital origin?

• Published in: Neuroradiology 2016-07, Vol.58 (7), p.687-695
• Main Authors: Shotar, Eimad, Guédon, Alexis, Sourour, Nader, Di Maria, Federico, Gabrieli, Joseph, Nouet, Aurélien, Chiras, Jacques, Clarençon, Frédéric
• Format: Article
• Language: English
• Subjects: Anatomy & physiology; Angiography, Digital Subtraction; Brain; Cavernous Sinus - abnormalities; Cavernous Sinus - diagnostic imaging; Cavernous Sinus - pathology; Cerebral Angiography; Cerebral Veins - abnormalities; Cerebral Veins - diagnostic imaging; Cerebral Veins - pathology; Congenital diseases; Deformities; Female; France - epidemiology; Humans; Imaging; Incidence; Interventional Neuroradiology; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - epidemiology; Intracranial Arteriovenous Malformations - pathology; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neurons and Cognition; Neuroradiology; Neurosciences; Neurosurgery; Prevalence; Radiology; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Sinuses; Veins & arteries
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-016-1679-9

Introduction The aim of this study was to test the hypothesis that the superficial middle cerebral vein (SMCV) is frequently absent or fails to connect with the cavernous sinus (CS) in the presence of brain arteriovenous malformations (AVMs), a frequently reported argument for the congenital origin of brain AVMs. Methods The SMCV was retrospectively compared between patients with a brain AVM and a control group. The presence or absence of the SMCV, its direct or indirect connection to the CS and its termination in a laterocavernous sinus (LCS), paracavernous sinus (PCS), or directly in the CS was studied on digital subtraction angiography. Results One hundred twenty-five left or right side carotid angiograms from 70 patients with a brain AVM were compared to 125 angiograms from 74 controls. The SMCV was present in 88 (70.4 %) cases in the brain AVM group and 96 (76.8 %) cases in controls ( p  = 0.25). The SMCV was connected directly or indirectly to the CS in 65 (52 %) cases in the brain AVM group and 65 (52 %) cases in controls ( p  = 1). When comparing the subgroup of carotid angiograms ipsilateral to a supratentorial AVM, no statistically significant difference was found with controls. In three of six cases in which a SMCV drained an AVM, the vein terminated directly or indirectly in the CS. Conclusions No difference of SMCV presence and direct or indirect connection to the CS was found between patients with AVM and a control group. SMCV anatomy does not support the congenital origin of brain AVMs.