Falcotentorial Location of Dural Arteriovenous Fistulas Derived from the Neural Crest as a Risk Factor for Aggressive Clinical Course
The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group on the membranous bone (DM group), and a falcotentorial group (FT group) in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragma sellae. The FT group was derived from the neural crest and designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized in the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The FT group was formed only with the dura propria that was considered as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs.
KeywordsDorsal mesoderm Dura propria Dural arteriovenous fistulas Endochondral bone Membranous bone Neural crest Paraxial mesoderm
Dural arteriovenous fistulas
- DM group
Dorsal membranous bone group
Digital subtraction angiography
- FT group
Magnetic resonance imaging
- VE group
Ventral endochondral group
The author thanks Dr. Giuseppe Esposito and Prof. Tetsuya Tsukahara for their proposal and organization to publish this chapter.
Conflicts of interest disclosure: The author reports no conflict of interest concerning the materials or methods used or the findings specified in this study.
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