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

Abstract

Arterial blood supply to a brain arteriovenous malformation (BAVM) is mainly derived from the internal carotid artery (ICA) and vertebral basilar artery (VBA) system. However, in certain cases, arteries supplying the meninges may also contribute to the blood supply of the BAVM, resulting in the formation of a BAVM with transdural blood supply (TBS). To review the current status of BAVM with TBS, a literature search was performed in the PubMed database. Articles were screened for relevance and suitability of data. According to recent studies, the mechanisms by which TBS to a BAVM forms are mainly classified into the congenital and acquired type. BAVM with TBS is common in elderly patients and is characterized by intracranial hemorrhage, epilepsy, chronic headache and increased intracranial pressure. Digital subtraction angiography is the gold standard for diagnosing BAVM with TBS. Superselective angiography is also important. Treatments for BAVM with TBS include surgical resection, endovascular treatment (EVT), stereotactic radiosurgery and combined treatment. Surgical resection is difficult to perform. EVT has become the major therapy for treating BAVM with TBS due to its low procedural invasiveness. Combination of surgical resection and EVT may be a good option. In addition, stereotactic radiosurgery is frequently used as a complementary treatment to surgical and endovascular interventions. The prognosis of BAVM with TBS is not favorable, as the defect involves a complex arterial supply system.

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

“…The main feeding arteries of a BAVM are mostly the ICA and VA. In rare circumstances, the BAVM can also recruit a TBS from the ECA or meningeal branches of the ICA and VA ( 2 ). A TBS to a BAVM is rare, the actual incidence of which remains to be elucidated.…”

“…To date, the precise pathophysiological mechanism of a TBS is still obscure. A TBS may develop simultaneously with the genesis of BAVMs or develop after the formation of BAVMs ( 2 , 4 ). According to Bervini et al, there are 3 possible explanations for the genesis of a TBS to a BAVM, which include (1) the development of a TBS upon the generation of the BAVM; (2) recruitment of transdural collaterals to the BAVM as a result of the BAVM-induced hypoxic environment; and (3) recruitment of the transdural arteries as a result of the BAVM-induced high wall shear stress ( 4 ).…”

“…The treatment of a BAVM with a TBS includes EVT, microsurgery, and stereotactic radiosurgery ( 2 ). Ideally, the goal of BAVM treatment is complete BAVM eradication.…”

“…However, in rare circumstances, a BAVM can recruit a transdural blood supply (TBS), which is more common in dural arteriovenous fistula (DAVF) and moyamoya disease (MMD) ( 1 ). A TBS may be derived from meningeal branches of the internal carotid artery (ICA), the external carotid artery (ECA), and the vertebral artery (VA) ( 2 ).…”

Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

“…A brain arteriovenous malformation (BAVM) is a common congenital vascular disease that belongs to the abnormal nidus between arteries and veins, which lacks an intervening capillary network and is characterized by a complex, tangled web of abnormal vessels ( 1 , 2 ). Moreover, BAVMs recruit blood supply from their neighboring arteries and drain to the adjacent veins ( 3 ). BAVMs in different positions may have different characteristics ( 4 ).…”