DAVFs with pial arterial supply (PAS) are associated with higher angiographic grades, increased venous dilation, and significantly lower complete obliteration rates, though major complication rates can be comparable to those of DAVFs without PAS with careful technique and appropriate surgical strategies.
Pial arterial supply (PAS) was identified in 19.4% of intracranial DAVF patients in this cohort.
DAVFs with PAS were more frequently located at the cerebral convexity and tentorium compared to DAVFs without PAS.
DAVFs with PAS were associated with higher angiographic grades and greater venous dilation than DAVFs without PAS.
DAVFs with PAS were more often managed with endovascular treatment compared to DAVFs without PAS.
DAVFs with PAS had significantly lower complete obliteration rates compared to DAVFs without PAS.
Major complication rates, including postoperative intracranial hemorrhage (ICH) and cerebral infarction, were similar between DAVFs with and without PAS.
This research examined a specific subtype of abnormal blood vessel connections in the brain called dural arteriovenous fistulas (DAVFs), focusing on those that also receive blood supply from arteries within the brain itself (called pial arterial supply, or PAS). In a group of 227 patients treated at one hospital, about 1 in 5 (19.4%) had this more complex form of DAVF. These cases tended to occur more often on the surface of the brain and at the tentorium (a membrane separating parts of the brain), and they showed more severe vascular changes — including higher severity grades and more enlarged veins — compared to simpler DAVFs. Despite their greater complexity, patients with PAS-type DAVFs did not appear to experience notably different symptoms before treatment compared to those with simpler DAVFs. However, treatment was more challenging: patients with PAS-type DAVFs were more likely to be treated using catheter-based (endovascular) procedures, and they were less likely to achieve complete closure of the abnormal vessels. For complex cases in certain locations (such as the front of the skull base or near the base of the spine), a combination of surgical and endovascular approaches appeared to be effective. This research suggests that the presence of pial arterial supply is an important feature to identify before treating a DAVF, as it signals greater complexity and a lower chance of complete cure with standard approaches. Despite these challenges, serious complications like bleeding or stroke after treatment were not more common in the PAS group, suggesting that with careful planning and technique, these difficult cases can still be managed safely.
Yuan S, Chen X, Zhao W, Feng Y, Wu Y, Chen H, et al.. (2026). Intracranial dural arteriovenous fistulas with and without pial arterial supply: a case series of 227 patients.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1872358