title: Superficial middle cerebral vein connection to the cavernous sinus is not infrequent in brain arteriovenous malformations: an argument against their congenital origin?
abstract: BACKGROUND
  The aim of this study was to test the hypothesis that the superficial middle cerebral vein (SMCV) is frequently absent or fails to connect with the cavernous sinus (CS) in the presence of brain arteriovenous malformations (AVMs), a frequently reported argument for the congenital origin of brain AVMs.
  
  
  METHODS
  The SMCV was retrospectively compared between patients with a brain AVM and a control group. The presence or absence of the SMCV, its direct or indirect connection to the CS and its termination in a laterocavernous sinus (LCS), paracavernous sinus (PCS), or directly in the CS was studied on digital subtraction angiography.
  
  
  RESULTS
  One hundred twenty-five left or right side carotid angiograms from 70 patients with a brain AVM were compared to 125 angiograms from 74 controls. The SMCV was present in 88 (70.4 %) cases in the brain AVM group and 96 (76.8 %) cases in controls (p = 0.25). The SMCV was connected directly or indirectly to the CS in 65 (52 %) cases in the brain AVM group and 65 (52 %) cases in controls (p = 1). When comparing the subgroup of carotid angiograms ipsilateral to a supratentorial AVM, no statistically significant difference was found with controls. In three of six cases in which a SMCV drained an AVM, the vein terminated directly or indirectly in the CS.
  
  
  CONCLUSIONS
  No difference of SMCV presence and direct or indirect connection to the CS was found between patients with AVM and a control group. SMCV anatomy does not support the congenital origin of brain AVMs.
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Eimad
authors.initials: E
authors.lastname: Shotar
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Guédon
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Nader
authors.initials: N
authors.lastname: Sourour
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Maria
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.|Paris VI University, Pierre et Marie Curie, Paris, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gabrieli
authors.affiliation: Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Nouet
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.|Paris VI University, Pierre et Marie Curie, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Chiras
authors.affiliation: Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France. fredclare5@msn.com.|Paris VI University, Pierre et Marie Curie, Paris, France. fredclare5@msn.com.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Clarençon
mesh_terms: D015901:Angiography, Digital Subtraction; D002426:Cavernous Sinus / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology*; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: Arteriovenous malformations; Congenital origin; Connection; Postnatal development; Superficial middle cerebral vein