ABSTRACT Background Frontal base mixed pial‐dural arteriovenous malformations (MPD‐AVMs) are rare intracranial vascular malformations with both pial and dural components. Although they share some angioarchitectural similarities with anterior cranial fossa dural arteriovenous fistulas (ACF‐DAVFs), the two represent different pathological processes, as ACF‐DAVFs are supplied exclusively by dural arteries. This study provides an overview of frontal base MPD‐AVMs, highlighting their differences from ACF‐DAVFs, and discusses the therapeutic implications of their distinct angioarchitectural features. Methods This is a single‐center case series study conducted between January 2018 and December 2024. The data of 11 patients who underwent endovascular treatment for frontal base MPD‐AVMs and 29 patients diagnosed with ACF‐DAVFs were retrospectively reviewed. Results In patients diagnosed with MPD‐AVMs, all lesions were supplied by the anterior ethmoidal artery (AEA) and orbitofrontal artery (OFA). Flow‐related aneurysms in the OFA were identified in seven patients (7/11, 63.6%), with three presenting with hemorrhagic events. Treatment approaches included transarterial embolization (TAE) in eight patients, with one requiring additional transvenous embolization (TVE). Primary TVE was employed in three patients, including two hemorrhagic patients who underwent staged treatment with initial aneurysm embolization. Complete obliteration was achieved in 72.7% of cases (8/11), although one patient experienced postoperative hemorrhage. In patients presenting with ACF‐DAVFs, venous aneurysm (18/29, 62.1%) might represent a risk factor for bleeding (13/29, 44.8%) ( p = 0.003). In the MPD‐AVM group, venous aneurysms were detected in five patients (5/11, 45.5%), but none of whom experienced hemorrhage. Conclusion Frontal base MPD‐AVMs represent distinct vascular anomalies from ACF‐DAVFs, often featuring anterior cerebral artery branch involvement. Tailored multi‐arterial endovascular strategies are crucial for optimizing outcomes and minimizing complications. Further studies with larger cohorts are essential to validate these observations and refine treatment guidelines.
Jiang et al. (Mon,) studied this question.