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DVA – Normal Variant, Do Not Resect — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseDVA – Normal Variant, Do Not ResectSCE Neurology

A 30-year-old man with epilepsy is found to have a left temporal developmental venous anomaly (DVA) on MRI performed for seizure investigation. There is no associated cavernoma or haemorrhage. The DVA is incidental. Should it be surgically removed?

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Correct answer: C — No — DVAs are normal anatomical variants of venous drainage and should NOT be resected; removing them can cause venous infarction as they drain normal brain tissue

Developmental venous anomalies (DVAs) are the most common cerebral vascular malformation, found in ~2.5% of MRI scans. They are considered normal variants of venous drainage — medullary veins drain normal brain tissue via the DVA into a collecting vein. Removing or occluding a DVA can cause venous infarction of the territory it drains. DVAs themselves almost never bleed. If a DVA is associated with a cavernous malformation (which occurs in ~20% of cases), the cavernoma may be resected but the DVA itself must be preserved. A: Resection causes venous infarction. C: Size is not an indication for treatment. D: Headaches are not typically caused by isolated DVAs. E: Embolisation would occlude the drainage and cause infarction.

Reference: NICE NG128; AVM/DVA Neurovascular Guidelines