, Volume 61, Issue 1, pp 9–9 | Cite as

Letter regarding “Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI”

  • Waleed BrinjikjiEmail author
  • Giuseppe Lanzino
Letter to the Editor

Dear Editor-in-Chief,

We read with interest the case reported by Geraldo et al. titled “Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI” [1]. In this article, the authors reported a case of a DVA in the left parietal lobe with a large subependymal venous collector. The authors state that the case report supports the concept of DVAs as congenital lesions.

While we certainly agree that DVAs may develop in utero and, on occasion, can present during fetal life, we believe that many DVAs actually form in post-natal life when venous development is still active. In a recently published article, we reviewed post-contrast MRIs of over 18,000 individuals and found that DVAs were present in 1.5% of patients < 1 year old, 7.1% of patients 1–5 year old, 9.6% of patients 6–17 years old, and 9.6% of patients ≥ 18 years old. There was a significant positive association between age and the presence of a DVA [2].

Rather than DVAs necessarily being congenital lesions, we believe that DVAs form in the later periods of cerebral venous development as a functional adaptation to thrombosis or failure of development of superficial or deep veins. It is likely that late fetal or early post-natal venous occlusion triggers remodeling of medullary veins resulting in DVA formation. A late fetal venous occlusion is likely responsible for the isolated ventricular dilatation seen in this case report.

Furthermore, it is well established that venous development continues well into early human life [3]. There are substantial post-natal changes in venous architecture including cavernous sinus capture of the Sylvian vein and alterations in posterior fossa venous drainage in humans. There have been a few bona fide case reports of de novo DVA formation in young children [4]. There are even studies demonstrating an association between CNS neoplasms and DVAs in young children—a finding suggesting that post-natal venous remodeling can occur due to a variety of stimuli, including neoplasms [5].

We would like to thank the authors for their valuable contribution to the literature. The ability to use fetal MRI to further understand the pathogenesis of DVAs and other cerebrovascular diseases is invaluable.


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval


Informed consent



  1. 1.
    Geraldo AF, Melo M, Monteiro D et al (2018) Developmetal venous anomaly depicted incidentally in fetal MRI and conformed in post-natal MRI. Neuroradiology 60(10):993-994Google Scholar
  2. 2.
    Brinjikji W, El-Raid EA, Wald JT et al (2017) Prevalence of developmental venous anomalies increases with age. Stroke 48(7):1997–1999CrossRefGoogle Scholar
  3. 3.
    Padget DH (1956) The cranial venous system in man in reference to development, adult configuration, and relation to the arteries. Am J Anat 98:307–355CrossRefGoogle Scholar
  4. 4.
    Leach JK, Howard T, Abruzzo T (2012) Postnatal evoluation of a developmental venous anomaly. J Pediatr Neuroradiol 24:135–143Google Scholar
  5. 5.
    Jones BV, Linscott L, Koberlein G, Hummel TR, Leach JL (2015) Increased prevalence of developmental venous anomalies in children with intracranial neoplasms. AJNR Am J Neuroradiol 36:1782–1785CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyMayo ClinicRochesterUSA
  2. 2.NeurosurgeryMayo ClinicRochesterUSA

Personalised recommendations