Involvement of Dural Arteries in Intracranial Arteriovenous Malformations

Published Online:https://doi.org/10.1148/93.5.1071

Intracranial arteriovenous malformations may receive part or all of their blood supply from meningeal branches of the external carotid, internal carotid, or vertebral arteries, although previous authors(2–5,8, 10, 15–17,20,21,24)have suggested that such a meningeal contribution is infrequent. The malformations may be classified on the basis of their arterial supply as pure pial, mixed pial and dural, and pure dural. Those that are entirely pial in location are supplied solely by cerebral or cerebellar arteries. Mixed pial and dural malformations receive their blood supply not only from cerebral or cerebellar arteries but also from meningeal vessels. Pure dural malformations are limited to the dura and thus receive only meningeal arterial contribution.

The purpose of this study was to evaluate the location of intracranial arteriovenous malformations based on the presence or absence of a dural blood supply.

Method

Arteriograms of patients with intra-cranial arteriovenous malformations examined at the University of California Medical Center, San Francisco (UCSF), and the University of Lund, Sweden, during a six-year period (1962–1968) were reviewed. The malformations were classified by location into supratentorial and infratentorial. On the basis of the arterial blood supply they were further subdivided into pure pial, mixed pial-dural, and pure dural lesions. The source and extent of the meningeal arterial supply in patients with dural involvement were tabulated. The demonstration of dural involvement frequently depended upon opacification of meningeal branches of the external carotid artery. For this reason, the extent of opacification of the external carotid artery and its branches was analyzed.

Results

Roentgenograms of 129 (79 UCSF, 50 Lund) intracranial arteriovenous malformations were available for review. Of these, 103 (80 per cent) were supratentorial and 26 (20 per cent) were infratentorial (TABLE I). Dural involvement, as judged by meningeal arterial contribution to the malformation, was found in 35 patients (27 per cent). Supratentorial arterio-venous malformations far outnumbered those below the tentorium. Pure dural or mixed pial-dural involvement, however, appeared to be proportionally more common in the posterior fossa (50 per cent) (Fig. 1) than in the supratentorial compartment (21 per cent) (Fig. 2). Arterio-venous malformations limited to the dura and supplied by meningeal arteries alone were more common in the posterior fossa (35 per cent) (Fig. 3) than were those above the tentorium (6 per cent) (Fig. 4).

The recognition of a meningeal arterial supply depends upon adequate opacification of the meningeal arteries that may be supplying the malformation; for this reason, the extent of angiography, particularly the presence or absence of opacification of the external carotid artery and its branches, was also tabulated (TABLE II).

Article History

Accepted: July 1969
Published in print: Nov 1969