Recognition of dural to pial supply in high-grade dural arteriovenous fistula: A technical note

Shigeta Miyake ^1,2, Tze Phei Kee ^1,3, Ivan Radovanovic ⁴

⁰Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences +

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October 8, 2024

View abstract on PubMed

Summary

High-grade dural arteriovenous fistulas (DAVFs) can have unusual arterial supply routes. This study highlights the importance of recognizing dural to pial supply in complex DAVF cases during embolization.

Area Of Science

Neurology
Radiology
Vascular Surgery

Background

High-grade dural arteriovenous fistulas (DAVFs) typically exhibit classical dural arterial supply.
DAVFs can also present with pre-existing dural supply or pure arterial supply from pial branches, indicating congenital or acquired shunting.
Recognition of atypical supply routes is crucial for effective treatment.

Purpose Of The Study

To describe the identification of dural to pial supply in a high-grade DAVF.
To emphasize the significance of meticulous assessment during embolization procedures.
To highlight the utility of microcatheter injections in diagnosing complex DAVF anatomy.

Main Methods

Combined transarterial and transvenous embolization was performed.
Microcatheter injections were utilized for detailed anatomical assessment.
A high-grade DAVF with holocephalic venous reflux was treated.

Main Results

Dural to pial supply was successfully recognized during the procedure.
The findings underscore the variability in arterial supply patterns for high-grade DAVFs.
Careful microcatheter assessment proved essential for identifying this atypical supply.

Conclusions

Dural to pial supply is an important consideration in high-grade DAVFs.
Combined endovascular techniques and meticulous microcatheter evaluation are vital for accurate diagnosis and treatment planning.
This recognition aids in optimizing embolization strategies for complex DAVF cases.

Keywords:

Dural arteriovenous fistula VEGF dural supply endovascular treatment pial supply