Developmental venous anomaly related to de novo cerebral cavernous malformation: Imaging findings from two cases

The association between a developmental venous anomaly (DVA) and a cerebral cavernous malformation (CCM) is well-established. The development of a de novo CCM (dnCCM) adjacent to a preexisting DVA suggests that certain characteristics of the angioarchitecture of the DVA, in addition to genetic and molecular factors, play a critical role in its pathogenesis. We present the cases of two patients who were initially diagnosed with a DVA in different locations (left frontal and left occipital lobes) without evidence of a CCM in their initial imaging studies. During the follow-up, new lesions that were consistent with a dnCCM were identified adjacent to the DVA. One patient underwent surgical resection, and histopathology confirmed the CCM. Our findings support the postulate that the chronic hemodynamic alterations induced by the angioarchitecture of the DVA enable the formation of a dnCCM, as documented in the cases presented. These findings suggest that patients with a DVA who have hemodynamic risk factors may benefit from follow-up neuroimaging examinations. While our cases were monitored with standard MRI sequences, advanced techniques such as perfusion imaging might provide further insights into the hemodynamic mechanisms at play in future studies. Furthermore, we emphasize the need for longitudinal studies to establish a definitive causal relationship between DVA and dnCCM.