Objective To divide the patients with venous malformation (VM) into three groups based on tissue structure and histopathological characteristics, and analyze results from different treatment scheme in three groups for direction of treatment option according to tissue structure. Methods A retrospective analysis was performed on 170 cases with VM including 73 male and 97 female with mean age of (23.4±9.9) years in Department of Hemangioma this hospital from January 2015 to December 2019. There were 141 cases in enveloped group, 22 cases in non-enveloped group and 7 cases in ossification group with different type of tissue structure of specimens in each group. Patients were examined with image using ultrasonography, magnetic resonance imaging, X-rays and CT angiography. Patients were treated for VM with surgery or minimal invasive techniques. Intraoperative observation and postoperative pathological examination were performed on VM tissue. Visual analogue scale (VAS) and Oswestry disability index (ODI) were detected preoperatively and after discharge. Follow-up was done 163 cases after 1 year discharge and 7 cases lost. Results The data of image, tissue structure, histopathological features, treatment scheme and efficacy evaluation were gotten in three groups. There were 101 cases in enveloped group treated by surgery with 78 (77.2%) cases cured and 2 (2.0%) cases recurred. Remaining 40 cases were treated by minimal invasive operation including sclerotherapy intervention and radiofrequency ablation, in which 23 (57.5%) cases were cured and 2 (5.0%) cases were recurred. The patients in enveloped group had best pattern of tissue structure with best prognosis. Fifteen cases in non-enveloped group were operated with 3 (20.0%) cases cured and 4 (26.7%) cases recurred. Remaining 7 cases were treated by minimal invasive operation with 1 cured case and 3 (42.9%) recurred cases. The recurrence rate was high in non-enveloped group. In ossified group, 7 cases were all treated by surgery and cured without any recurrence. VAS of patients in both enveloped group and non-enveloped group were significantly lower than those before treatment. All patients had lower ODI at discharge than before treatment. There were 6 cases with complication such as delayed incision healing. Conclusions Tissue structure could be an effective index for treatment option and prognosis judgment for VM. The patients in enveloped group would have best results of treatment, while treatment results of patients in non-enveloped group are poor. Ossification of tissue structure is suitable only using surgical treatment.