Department of Endovascular Neurosurgery, Toranomon Hospital, 2-2-2, Toranomon, 105-8470, Minato, Tokyo, Japan.
Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Clin Neuroradiol. 2023 Jun;33(2):467-474. doi: 10.1007/s00062-022-01232-4. Epub 2022 Dec 7.
Arteriovenous fistulas (AVFs) adjacent to the clivus, such as cavernous sinus dural AVFs (CSDAVFs) and condylar AVFs, sometimes have an intraosseous shunted pouch and recruit blood supply from transosseous feeders. Precise analysis of transosseous feeders regarding the clival lesion has not yet been performed. Therefore, this study aimed to clarify the characteristics and identity of transosseous feeders in clival lesions.
Patients with CSDAVFs and condylar AVFs, who underwent high-resolution cone-beam computed tomography or three-dimensional rotational angiography in our institute, were included. The frequency, type of branch, penetrating point, and termination of intraosseous feeders were retrospectively evaluated.
A total of 31 patients with 36 lesions in CSDAVFs and 8 patients with 8 lesions in condylar AVFs underwent angiography. For CSDAVFs, 38 transosseous feeders were detected in 23 out of 31 patients, including 22 in the pharyngeal branch of the ascending pharyngeal artery (APhA), 6 in the hypoglossal branch of the APhA, 6 in the accessory meningeal artery, 3 in the meningohypophyseal trunk (MHT), and 1 in the anterior branch of the middle meningeal artery. For condylar AVFs, 24 transosseous feeders were detected in all 8 patients, including 11 in the pharyngeal branches of the APhA, 7 in the hypoglossal branch of the APhA, 6 in the segmental artery from the vertebral artery, and 2 in the MHT.
Transosseous feeders of AVFs around the clivus, which are frequently seen in AVFs of this area, mainly arise from ventral clival branches and from pharyngeal branches of the APhA.
毗邻斜坡的动静脉瘘（AVF），如海绵窦硬膜动静脉瘘（CSDAVF）和髁突 AVF，有时具有骨内分流囊，并从骨内供血动脉获得血液供应。对于斜坡病变的骨内供血动脉，尚未进行精确分析。因此，本研究旨在阐明斜坡病变中骨内供血动脉的特征和来源。
纳入在我院行高分辨率锥形束 CT 或三维旋转血管造影的 CSDAVF 和髁突 AVF 患者。回顾性评估骨内供血动脉的频率、分支类型、穿透点和终止点。
共 31 例 CSDAVF 患者 36 个病变和 8 例髁突 AVF 患者 8 个病变进行了血管造影。对于 CSDAVF，31 例患者中有 23 例发现 38 个骨内供血动脉，包括咽升动脉咽支 22 个、咽升动脉舌下神经支 6 个、脑膜副动脉 6 个、脑膜垂体干 3 个和脑膜中动脉前支 1 个。对于髁突 AVF，8 例患者均发现 24 个骨内供血动脉，包括咽升动脉咽支 11 个、咽升动脉舌下神经支 7 个、椎动脉节段动脉 6 个和脑膜垂体干 2 个。
在该区域的 AVF 中常见的毗邻斜坡的 AVF 的骨内供血动脉主要来源于斜坡腹侧分支和咽升动脉咽支。
