Mixed Pial-Dural Arteriovenous Malformation in the Anterior Cranial Fossa Two Case Reports

• Published in: Neurologia medico-chirurgica Vol. 50; no. 6; pp. 470 - 475
• Main Authors: JIMBO, Hiroyuki, IKEDA, Yukio, IZAWA, Hitoshi, OTSUKA, Kuninori, HARAOKA, Jo
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2010; THE JAPAN NEUROSURGICAL SOCIETY
• Subjects: Aged; anterior cranial fossa; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - pathology; Central Nervous System Vascular Malformations - surgery; Cerebral Veins - abnormalities; Cranial Fossa, Anterior - diagnostic imaging; Cranial Fossa, Anterior - pathology; Cranial Fossa, Anterior - surgery; Cranial Sinuses - abnormalities; Dura Mater - abnormalities; Dura Mater - blood supply; Dura Mater - diagnostic imaging; Frontal Lobe - blood supply; Frontal Lobe - pathology; Humans; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - pathology; Intracranial Arteriovenous Malformations - surgery; Male; meningeal artery; mixed pial-dural arteriovenous malformation; Ophthalmic Artery - abnormalities; Pia Mater - abnormalities; Pia Mater - blood supply; Pia Mater - diagnostic imaging; pial artery; Radiography; surgical resection
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.50.470

Most arteriovenous malformations (AVMs) associated with the meningeal artery in the anterior cranial fossa are the pure dural type, and mixed pial-dural AVMs are rare. Two types of mixed pial-dural AVM occur in the anterior cranial fossa according to the shunting point: one with the nidus in the brain parenchyma of the frontal lobe, and the other with the shunting point in the dura mater. We describe two patients with AVMs fed by the anterior ethmoidal arteries and the persistent primitive olfactory artery, with the nidus located in the pure brain parenchyma of the inferior aspect of frontal lobe, and drained via an abnormal cortical vein into the cavernous and superior sagittal sinuses. The importance of occluding the venous outflow to obliterate intracranial dural arteriovenous fistula (AVF) is emphasized. However, removal of the nidus in the brain parenchyma is required. The presence of a pial feeder should be considered before diagnosis of dural AVF of the anterior cranial fossa, and preoperative detailed evaluation for the pial supply and shunting point is mandatory.