Background The dural vasculature plays a key role in several important conditions, including dural fistulas and subdural collections. While in vivo investigations of intrinsic dural arterial angioarchitecture are rare, no angiographic studies of dural venous drainage exist to our knowledge.
Objective To describe methods by which dural venous drainage might be visualized with current angiographic equipment and technique, and to correlate our results with existing ex vivo literature.
Methods Digital subtraction angiography and 3D angiography (rotational and Dyna CT) of dural neurovasculature were acquired in the context of subdural hematoma embolization and normal dura. Protocols for visualization of dural venous drainage were established, and findings correlated with ex vivo studies.
Results Meningeal arteries supply both the skull and dura. Normal dural enhancement is accentuated by the presence of hypervascular membranes. Intrinsic meningeal veins/sinuses parallel outer layer arteries with well-known tram-tracking appearance. Dura adjacent to main arterial trunks drains via skull base foramina into the pterygopalatine venous plexus, or via emissary veins into the temporalis venous plexus. Dura near the sinuses drains into venous pouches adjacent to the sinus, before emptying into the sinus proper—possibly the same pouches implicated in the angioarchitecture of dural fistulas. Finally, posterior temporoparietal convexity dura, situated in a watershed-like region between middle and posterior meningeal territories, frequently empties into diploic and emissary veins of the skull. Wide variation in balance is expected between these three routes. Drainage patterns appear to correlate with venous embryologic investigations of Padget and ex vivo studies in adults.
Conclusions Continued attention to dural venous drainage may prove useful in the diagnosis and management of dural-based vascular diseases.
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Contributors Substantial contributions to the conception or design of the work: MS, ER, EN, MW, OM, PKN. Acquisition, analysis, or interpretation of data for the work: MS, ER, EN, OM, MW, KS, PKN. Drafting the work or revising it critically for important intellectual content: MS, ER, EN, OM, MW, KS, PKN. Final approval of the version to be published: MS, ER, EN, OM, MW, KS, PKN. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.
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 MS: consultant to Medtronic. ER: Siemens: stockholder; Rapid Medical: travel; Phenox: Site PI PROST trial; Medtronic: Site PI ADVANCE trial. EN: consultant to Rapid Medical. KS: consultant to Kaneka Medix Corporation. MW: educational consultant to Medtronic.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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