Ventral Clival Branch of the Ascending Pharyngeal Artery as aTransosseous Feeder of an Arteriovenous Fistula Surrounding the Clival Lesions.

Abstract

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. Atotal of 31patients with 36 lesions in CSDAVFs and 8 patients with 8 lesions in condylar AVFs underwent angiography. For CSDAVFs, 38transosseous feeders were detected in 23 out of 31patients, including 22 in the pharyngeal branch of the ascending pharyngeal artery (APhA), 6in the hypoglossal branch of the APhA, 6 in the accessory meningeal artery, 3in the meningohypophyseal trunk (MHT), and 1 in the anterior branch of the middle meningeal artery. For condylar AVFs, 24transosseous feeders were detected in all 8 patients, including 11 in the pharyngeal branches of the APhA, 7in the hypoglossal branch of the APhA, 6in 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.