Is the Middle Meningeal Artery the Optimal Path for Dural Arteriovenous Fistula Embolization?

Abstract

Background: The middle meningeal artery (MMA) is the optimal arterial path for endovascular treatment (EVT) of dural arteriovenous fistulas (DAVFs). However, the details are not completely understood.Materials and Methods: We performed a retrospective study of patients who were admitted to the First Hospital of Jilin University with a diagnosis of cranial DAVF with involvement of the MMA as a feeding artery. On the basis of the arterial path chosen and the role of the MMA in the first EVT procedure, EVT was divided into three types (I–III), each of which was further divided into two subclasses (a and b). The degree of embolization was analyzed.Result: The 104 included patients ranged in age from 13 to 80 years (mean, 53.6 ± 11.8 years). There were 48 cases of hemorrhage (46.2%, 48/104). Complete embolization was achieved in the first procedure in 64.4% of cases, and success was eventually achieved using EVT (the first attempt or a subsequent attempt) in 74.1% of cases. EVT caused complications in 6.7% of cases. A modified Rankin scale score of 0 or 1 was achieved in 78.8% of patients. Statistical analyses revealed that type Ia and IIb EVTs had the lowest complete embolization rates, but no difference was found between type Ia and IIb EVTs. Types IIa and III EVT had the highest complete embolization rates. Most cases had a good prognosis.Conclusion: These findings elucidate the features of the different EVT classes defined by the first EVT procedure and the role of the MMA. The delivery of treatment via slim and tortuous MMA branches increased the failure rate of EVT. A thick, straight MMA branch is the optimal path for treatment.

Case report: Onyx embolization of tentorial dural arteriovenous fistula via the meningohypophyseal trunk and medial tentorial artery of Bernasconi-Cassinari

“…In a systematic review by Cannizzaro et al, over the past 35 years, TDAVFs have increasingly been treated with EVT, and the use of the Onyx liquid embolic system may continue to shift the balance increasingly toward EVT ( 12 ). Of all feeding arteries that can potentially be used as transarterial paths to perform EVT, the MMA is still the gold transarterial path to complete the obliteration of the TDAVF ( 7 ). The MHA and MTA of Bernasconi-Cassinari are challenging for TDAVF, and the success rate is low, such as in case 2.…”

“…( 1 ). In addition, the meningeal branches of intracranial pial arteries can be involved as feeders, such as the artery of Davidoff and Schecter of the posterior cerebral artery, the artery of Wollschlaeger and Wollschlaeger of the superior cerebellar artery (SCA) ( 6 , 7 ).…”

Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery

“…For patients with ICA stenosis and occlusion, the history of ICA stenosis and occlusion was chronic and progressive due to arteriosclerosis; in these patients, the ECA was normal and had no stenosis at the origin. No tumor or vascular diseases, such as scalp or intramuscular hemangioma ( 10 , 11 ), arteriovenous malformation ( 12 ), or DAVF ( 13 ), were associated with the OA.…”

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

“…Cervical DAVFs occur in <6% of spinal DAVFs ( 30 – 33 ). In most cervical DAVFs, the ASA acts as a bystander ( 34 – 36 ). Rarely, the ASA can be an accomplice.…”