Transdural Blood Supply in Cerebral Arteriovenous Malformations: A Systematic Evaluation of Angioarchitecture

Abstract

BACKGROUND AND PURPOSE: Arterial transdural blood supply is a rare angiographic phenomenon in cerebral AVMs. This study aimed to evaluate angiographic transdural blood supply characteristics and to describe the clinical peculiarities of these lesions. MATERIALS AND METHODS: A prospective AVM data base of 535 patients, enrolled from 1990 to 2016, was analyzed retrospectively. Clinical information was reviewed through patients' medical charts and radiologic studies. Patients with previous AVM treatment were excluded (n ϭ 28). RESULTS: Patients with (n ϭ 32, male/female ratio ϭ 10:22; mean age, 46 Ϯ 15 years; range, 13-75 years) and without transdural blood supply (n ϭ 475, male/female ratio ϭ 260:215; mean age, 40 Ϯ 18 years; range, 2-87 years) did not show significant differences in clinical presentation (age, hemorrhage, seizures, chronic headache). The predominant nidus size in patients with transdural blood supply was Ն30 mm, with significantly more patients with large AVMs (Ͼ60 mm, P ϭ .001). To describe the transdural blood supply, we used 3 grades based on the angiographic transdural blood supply proportion and intensity of AVM nidus perfusion (I-III). Fifty-seven percent of patients with chronic headache had a strong and substantial transdural nidus perfusion (III) and a high-flow transdural blood supply. CONCLUSIONS: Cerebral AVMs with transdural blood supply represent a rare and heterogeneous subgroup. Lesions can be graded by quantifying the transdural blood supply of the nidus and by capturing hemodynamic characteristics. The broad spread of angiographic features and comparable clinical patterns of patients with or without transdural blood supply raises questions about the relevance of the transdural blood supply to the natural history risk of an AVM and the intention for treatment. ABBREVIATIONS: ECA ϭ external carotid artery; TDBS ϭ transdural blood supply

Angiographic Evaluation and Endovascular Treatment Considerations of Brain Arteriovenous Malformations With a Transdural Blood Supply: A Single-Center Experience

“…In this study, we found that there was no difference in age between the patients with and without a TBS, which was consistent with the study by Stein et al ( 5 ). Of note, we found that patients with higher SM grades tended to have a TBS, which was also consistent with past reports ( 1 , 3 , 5 ).…”

“…To explore the heterogeneity of TBSs, Stein et al classified TBSs into 3 types based on the proportion and intensity of BAVM nidi perfusion by ECA feeders ( 5 ). In the present study, we divided the TBSs into 3 types according to their sources as follows: TBSs originating from the unilateral ECA and/or VA, TBSs originating from the bilateral ECA and/or VA, and TBSs with involvement of the MHT ( Figures 2 , 4 ).…”

“…According to this classification, we could determine the origin of the TBS, which would be helpful when performing EVT for BAVMs via the TBS. In addition, our classification system is also a supplement to that by Stein et al ( 5 ).…”

“…Therefore, the clinical and radiologic characteristics of BAVMs with a TBS are poorly understood. Currently, studies focusing on BAVMs with a TBS are scarce, and only a few reports have been published ( 1 , 3 , 5 ). Due to the rarity of this entity, the published studies only had small sample sizes.…”

Brain arteriovenous malformation with transdural blood supply: Current status (Review)

“…The clinical manifestations of BAVM with TBS are similar but not identical to those of BAVM without TBS. The blood-supplying artery of a BAVM with TBS involves the dura; thus, the clinical manifestations of the BAVM share the characteristics of the dura (31). However, the major clinical manifestations are associated with the size and location of the BAVM.…”