Radiological anatomy of the vascularization of cranial dural arteriovenous malformations

Abstract

Knowledge of the radiological anatomy of the cranial dural vascularization allows a flexible and appropriate approach to the pretherapeutic investigation of cranial dural arteriovenous malformations. The variability of the origin of these arteries requires that several possible sources of vascular supply be investigated - internal carotid, internal maxillary, ascending pharyngeal, occipital and vertebral - and that each of their meningeal branches be known in detail. Finally, familiarity with the radiological anatomy of these vessels allows one to identify on routine angiography those vessels that may be a source of risk when performing techniques of endovascular therapy (pedicles supplying the cranial nerves, internal carotid and vertebral anastomoses). Each foramen at the base and vault of the cranium contains an artery to the dura mater. Accordingly, very precise topographical study, in particular of the cavernous region, can be made.

Dural Arteriovenous Malformations: A Review of the Literature and a Presentation of the JHN Series

“…1,59,60 The use of flow-guided catheter technology and increased experience with particle and glue embolization as well as detachable coils have greatly improved the safety and efficacy of this method. [61][62][63] However, transarterial embolization rarely succeeds in totally eliminating and curing a DAVM, except in rare instances of limited fistulae with a small number of accessible feeders.…”

“…In contrast, some DAVMs may demonstrate increase in size from either arterial or venous enlargement 1,12,36 or even de novo development. 37 Pachymeningeal arterial feeders may be progressively recruited with enlargement of the nidus.…”

“…1 The etiology of these lesions is not fully understood. DAVMs in the pediatric population are associated with structural venous abnormalities , 2 but the majority of DAVMs are thought to be acquired.…”

Dural Arteriovenous Fistulas*

“…Less frequent is the arterial inflow from meningeal branches of the vertebral artery [5,40]. Always consider the possibility of arterial supply from the subclavian artery, especially if there is a suspected DAVF type V according to the MRI but no arterial feeder found yet.…”

“…These fistulas are relatively uncommon and represent approximately 10-15% of all intracranial arteriovenous shunts [3]. Arterial supply is from the meningeal branches in the vicinity, these are usually from an extracranial but sometimes, to a lesser extent, from an intracranial source [4,5]. The clinical symptoms are highly dependent on the venous drainage [6,7].…”