The significance of dural supply of central nervous system lesions

The authors present several situations in which participation of a meningeal artery in the supply of a central nervous system lesion does not mean that the dura mater is invaded. A vascular malformation of the brain or a high flow vascular malformation of the scalp may modify the caliber of meningeal arteries at a distance from the lesion; yet these arteries are healthy, and their non-pathological dilatation can be reversed by correcting the high flow. Elsewhere, recruitment by an axial tumour of neuromeningeal arteries indicates invasion of the peripheral nerves supplied without the dura mater necessarily being invaded. In contrast, recruitment by an axial tumour of pure meningeal arteries is a sign of extension to the adjacent dura mater. A study of such situations is essential when endovascular treatment is contemplated: some apparently 'dilated' vessels should be left untreated.