Presentation
Unusually big tentorial arteries in a patient with a dural AV-fistula. This pathological case was selected to demonstrate the anatomy. The left side features a big lateral tentorial artery, the right side a big medial tentorial artery (Artery of Bernasconi and Cassinari, artery of the free margin of the tentorium).
Patient Data
Left: Big lateral tentorial artery which anatomically runs along the lateral edge of the tentorium cerebelli towards the sigmoid sinus. In this particular case, we see several small branches with lateral directions. Angiographically this artery shows a downward course in the lateral projection.
Right: Big medial tentorial artery (also known as artery of Bernasconi and Cassinari) which runs along the medial (free) edge of the tentorium towards the confluence of sinuses), angiographically it shows an upward course in the lateral projection and stays near the midline in the ap projection.
Case Discussion
This pathological case was selected to better demonstrate the anatomy. There are unusually big tentorial arteries on both sides participating in the supply of a dural arteriovenous fistula (not all images shown) mainly draining into the left sigmoid sinus.
Both arteries (the lateral and medial tentorial artery) often arise from the meningeohypophyseal trunk (MHT) which itself arises from the cavernous segment of the internal carotid artery, however variant anatomy exists like the medial tentorial artery originating from the inferolateral trunk or even ophthalmic artery.
These arteries are hardly visualized on angiography in the absence of pathologically increased tentorial blood flow, like in tentorial tumors and tentorial dural arteriovenous fistula (DAVF) like in this case.
Case imaging courtesy of Prof. R. Chapot (Alfried Krupp Krankenhaus Essen, Germany).