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Transdural Blood Supply to Cerebral Arteriovenous Malformations Adjacent to the Dura Mater

Michael Södermana,b, Georges Rodeschc and Pierre Lasjauniasc

a Department of Neuroradiology, Stockholm, Sweden
b Karolinska Hospital, Stockholm, Sweden
c the Neuroradiologie Vasculaire, Hôpital de Bicêtre, France



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  		FIG 1. Distribution of the 107 patients with AVMs adjacent to the dura mater who were admitted for treatment with embolization in 1997–1999.



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  		FIG 2. Lobar distribution of the 86 AVMs in the study. Each group is divided according to the presence of a TBS before embolization.



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  		FIG 3. The distribution of the 81 AVMs in this study, according to the Spetzler-Martin grades. Five patients were omitted because of missing angiograms (posteroanterior) views from the first examination). Each group is divided according to the presence of a TBS before embolization.



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  		FIG 4. Lobar distribution of the 32 patients who initially had no transdural supply to the AVM and who then underwent at least one embolization procedure with follow-up angiography. Each group is divided according to the presence of a TBS at the end of the mean treatment time of 12 months.



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  		FIG 5. Findings in a 10-year-old boy with two AVMs: one in the right frontal lobe adjacent to the sylvian fissure and one in the right parietal lobe. Before embolization, the patient had bled from the frontal AVM. All images are lateral angiograms.

A, Internal carotid arterial (ICA) injection before embolization.

B, External carotid arterial (ECA) injection before embolization.

C, ECA injection 3 months after partial NBCA embolization of the parietal nidus. Note the emerging TBS to the parietal nidus but not to the frontal nidus.

D, ECA injection 28 months after the first NBCA embolization. Note the increase in the TBS to the parietal nidus. The frontal nidus still has a purely pial blood supply.

E, ICA injection 28 months after the first NBCA embolization. Note the lack of contrast-agent filling in the part of the parietal nidus over taken by the TBS.

F, Embolization of the frontal nidus (after the image E was obtained). Note the intranidal filling of NBCA.

G, Nonsubtracted lateral view obtained without the injection of contrast material after the last embolization procedure (performed 28 months after the first procedure). Image shows partly proximal and feeder embolization in the parietal AVM and better penetration in the anterior nidus.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X