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Clinical, angiographic, and treatment characteristics of cranial dural arteriovenous fistulas with pial arterial supply
  1. Waleed Brinjikji1,2,
  2. Harry J Cloft1,2,
  3. Giuseppe Lanzino1,2
  1. 1 Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  2. 2 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Waleed Brinjikji, Mayo Clinic Minnesota, Rochester, MN 55902, USA; Brinjikji.Waleed{at}


Background The prevalence of pial arterial supply to cranial dural arteriovenous fistulas (dAVF) and its implication in the management of these fistulas is not well characterized. We performed a retrospective study to characterize pial arterial supply to dural arteriovenous fistulas and the implications for treatment.

Methods Consecutive patients evaluated over a 12-year period were retrospectively reviewed. Angiograms were reviewed to characterize dAVF angioarchitecture and the presence of pial artery supply. Pial artery supply was categorized as dilated pre-existing dural branches and pure pial supply. We then studied the association between pial artery supply and clinical, angiographic, and treatment features.

Results A total of 201 patients were included of which 27 (13.4%) had pial artery supply. Of these, 11 had supply from dilated pre-existing dural branches, nine had pure pial supply,and seven had both. There was a higher rate of dAVF rupture in the pial supply group (30.8% vs 9.8%, P=0.003) and these fistulas had a higher rate of Borden 2 and 3 (88.9% vs 38.4%, P<0.0001). Fistulas with pial artery supply had similar rates of endovascular and gamma knife treatment, but were more likely to undergo surgery than those without pial supply (25.9% vs 10.4%, P=0.03). Major complication rates were similar between groups (0% vs 1.1%, P=0.55).

Conclusions More than 10% of dAVFs also have pial supply but this is not a contraindication to embolization. In our study pure pial supply was associated with a more aggressive fistula and was most common in tentorial dAVFs.

  • fistula
  • liquid embolic material

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  • Correction notice This article has been corrected since it was published Online First. Figures were previously in the wrong order. This has now been corrected.

  • Contributors WB: Study design, statistical analysis, data collection, drafting original manuscript. HC: Study design, data collection, critical revision of the manuscript, approval of final draft. GL: Study design, data collection, critical revision of the manuscript, approval of final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available upon reasonable request. Please email the corresponding author.