The Bernasconi-Cassinari Artery: A Key Vessel in the Pathogenesis of Dural Arteriovenous Fistulas
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Abstract
This scoping review aimed to explore the anatomical, physiological, and pathological characteristics of the Bernasconi-Cassinari artery (BCA) and its role in dural arteriovenous fistulas (DAVFs). Following the PRISMA-ScR framework, a comprehensive search was conducted across Scopus, PubMed, and EMBASE until January 28, 2025. The review addressed four key research questions: the anatomical features of the BCA, its contribution to DAVF pathogenesis, diagnostic techniques for identifying its involvement, and therapeutic strategies targeting it in DAVF management. Studies were included based on the PICO(S) framework, focusing on human subjects and peer-reviewed literature. Data extraction captured study characteristics, anatomical descriptions, pathophysiological mechanisms, diagnostic findings, and treatment outcomes. Narrative synthesis organized findings into four themes: BCA anatomy, DAVF pathogenesis, diagnostic approaches, and therapeutic interventions. Results highlighted the BCA's critical role as a feeder vessel in DAVFs, particularly in lesions involving the cavernous sinus and tentorial regions. Advanced imaging modalities like digital subtraction angiography (DSA) and high-resolution MRI have provided precise insights into its morphology and clinical relevance. Therapeutic strategies, including endovascular embolization and microsurgical interventions, demonstrated variable success rates depending on individual vascular anatomy. This review underscores the importance of understanding the BCA in DAVF management and identifies gaps in current knowledge, particularly regarding standardized diagnostic criteria and long-term outcomes of interventions.
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This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Zyck S, De Jesus O, Gould GC. Dural Arteriovenous Fistula. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jun 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532274/
Unnithan AKA, Das JM, Mehta P. Hemorrhagic Stroke. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jun 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559173/
Cognard C, Januel AC, Silva NA, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008 Feb;29(2):235–41.
Bashti M, Brusko GD, Daftari M, Jamshidi AM, Cardinal T, Luther E, et al. Bridging the gap between neuroimaging and neurosurgery: a case of epidural arteriovenous fistula with an intradural presentation. Illustrative case. J Neurosurg Case Lessons. 2024 Oct 7;8(15):CASE24331.
Tirakotai W, Benes L, Kappus C, Sure U, Farhoud A, Bien S, et al. Surgical management of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Neurosurg Rev. 2007 Jan;30(1):40–8; discussion 48-49.
Banerjee AD, Ezer H, Nanda A. The artery of Bernasconi and Cassinari: a morphometric study for superselective catheterization. AJNR Am J Neuroradiol. 2011 Oct;32(9):1751–5.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;n71.
McCormack IG, Xu L, Nerva J, Berry JF, Melgar M, Wysiadecki G, et al. Anatomy of the Dorsal Meningeal Artery Including Its Variations: Application to Skull Base Surgery and Diagnostic and Interventional Imaging. World Neurosurgery. 2021 Nov;155:e41–8.
Liu S, Lee DC, Tanoura T. Tentorial dural arteriovenous fistula of the medial tentorial artery. Radiol Case Rep. 2016 Sep;11(3):242–4.
Kusaka N, Tamiya T, Sugiu K, Tokunaga K, Nishiguchi M, Takayama K, et al. Combined Use of TruFill DCS Detachable Coil System and Guglielmi Detachable Coil for Embolization of Meningioma Fed by Branches of the Cavernous Internal Carotid Artery-Technical Case Report-: —Technical Case Report—. Neurol Med Chir(Tokyo). 2007;47(1):29–31.
Hetts SW, Tsai T, Cooke DL, Amans MR, Settecase F, Moftakhar P, et al. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes. AJNR Am J Neuroradiol. 2015 Oct;36(10):1912–9.
Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol. 2012 Jun;33(6):1007–13.
Proulx-Chartier L, Parenteau È, Li J, Dallaire JS, Areal CC, Kuramochi I, et al. Seizures associated with dural arteriovenous fistulas: A systematic review of cases. Epilepsy Research. 2025 Mar;211:107531.
Baharvahdat H, Ooi YC, Kim WJ, Mowla A, Coon AL, Colby GP. Updates in the management of cranial dural arteriovenous fistula. Stroke Vasc Neurol. 2020;5(1):50–8.
Miller TR, Gandhi D. Intracranial Dural Arteriovenous Fistulae: Clinical Presentation and Management Strategies. Stroke. 2015 Jul;46(7):2017–25.
Rabinov JD, Yoo AJ, Ogilvy CS, Carter BS, Hirsch JA. ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas. J Neurointerv Surg. 2013 Jul;5(4):306–10.
Apte RS, Chen DS, Ferrara N. VEGF in Signaling and Disease: Beyond Discovery and Development. Cell. 2019 Mar 7;176(6):1248–64.
Kim MS, Han DH, Kwon OK, Oh CW, Han MH. Clinical characteristics of dural arteriovenous fistula. J Clin Neurosci. 2002 Mar;9(2):147–55.
Morsi RZ, Baskaran A, Thind S, Carrión-Penagos J, Desai H, Kothari SA, et al. Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series. Indian J Otolaryngol Head Neck Surg. 2024 Apr;76(2):1554–62.
Pal A, Blanzy J, Gómez KJR, Preul MC, Vernon BL. Liquid Embolic Agents for Endovascular Embolization: A Review. Gels. 2023 May 4;9(5):378.
Main Article Content
Abstract
This scoping review aimed to explore the anatomical, physiological, and pathological characteristics of the Bernasconi-Cassinari artery (BCA) and its role in dural arteriovenous fistulas (DAVFs). Following the PRISMA-ScR framework, a comprehensive search was conducted across Scopus, PubMed, and EMBASE until January 28, 2025. The review addressed four key research questions: the anatomical features of the BCA, its contribution to DAVF pathogenesis, diagnostic techniques for identifying its involvement, and therapeutic strategies targeting it in DAVF management. Studies were included based on the PICO(S) framework, focusing on human subjects and peer-reviewed literature. Data extraction captured study characteristics, anatomical descriptions, pathophysiological mechanisms, diagnostic findings, and treatment outcomes. Narrative synthesis organized findings into four themes: BCA anatomy, DAVF pathogenesis, diagnostic approaches, and therapeutic interventions. Results highlighted the BCA's critical role as a feeder vessel in DAVFs, particularly in lesions involving the cavernous sinus and tentorial regions. Advanced imaging modalities like digital subtraction angiography (DSA) and high-resolution MRI have provided precise insights into its morphology and clinical relevance. Therapeutic strategies, including endovascular embolization and microsurgical interventions, demonstrated variable success rates depending on individual vascular anatomy. This review underscores the importance of understanding the BCA in DAVF management and identifies gaps in current knowledge, particularly regarding standardized diagnostic criteria and long-term outcomes of interventions.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Zyck S, De Jesus O, Gould GC. Dural Arteriovenous Fistula. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jun 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532274/
Unnithan AKA, Das JM, Mehta P. Hemorrhagic Stroke. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jun 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559173/
Cognard C, Januel AC, Silva NA, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008 Feb;29(2):235–41.
Bashti M, Brusko GD, Daftari M, Jamshidi AM, Cardinal T, Luther E, et al. Bridging the gap between neuroimaging and neurosurgery: a case of epidural arteriovenous fistula with an intradural presentation. Illustrative case. J Neurosurg Case Lessons. 2024 Oct 7;8(15):CASE24331.
Tirakotai W, Benes L, Kappus C, Sure U, Farhoud A, Bien S, et al. Surgical management of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Neurosurg Rev. 2007 Jan;30(1):40–8; discussion 48-49.
Banerjee AD, Ezer H, Nanda A. The artery of Bernasconi and Cassinari: a morphometric study for superselective catheterization. AJNR Am J Neuroradiol. 2011 Oct;32(9):1751–5.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;n71.
McCormack IG, Xu L, Nerva J, Berry JF, Melgar M, Wysiadecki G, et al. Anatomy of the Dorsal Meningeal Artery Including Its Variations: Application to Skull Base Surgery and Diagnostic and Interventional Imaging. World Neurosurgery. 2021 Nov;155:e41–8.
Liu S, Lee DC, Tanoura T. Tentorial dural arteriovenous fistula of the medial tentorial artery. Radiol Case Rep. 2016 Sep;11(3):242–4.
Kusaka N, Tamiya T, Sugiu K, Tokunaga K, Nishiguchi M, Takayama K, et al. Combined Use of TruFill DCS Detachable Coil System and Guglielmi Detachable Coil for Embolization of Meningioma Fed by Branches of the Cavernous Internal Carotid Artery-Technical Case Report-: —Technical Case Report—. Neurol Med Chir(Tokyo). 2007;47(1):29–31.
Hetts SW, Tsai T, Cooke DL, Amans MR, Settecase F, Moftakhar P, et al. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes. AJNR Am J Neuroradiol. 2015 Oct;36(10):1912–9.
Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol. 2012 Jun;33(6):1007–13.
Proulx-Chartier L, Parenteau È, Li J, Dallaire JS, Areal CC, Kuramochi I, et al. Seizures associated with dural arteriovenous fistulas: A systematic review of cases. Epilepsy Research. 2025 Mar;211:107531.
Baharvahdat H, Ooi YC, Kim WJ, Mowla A, Coon AL, Colby GP. Updates in the management of cranial dural arteriovenous fistula. Stroke Vasc Neurol. 2020;5(1):50–8.
Miller TR, Gandhi D. Intracranial Dural Arteriovenous Fistulae: Clinical Presentation and Management Strategies. Stroke. 2015 Jul;46(7):2017–25.
Rabinov JD, Yoo AJ, Ogilvy CS, Carter BS, Hirsch JA. ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas. J Neurointerv Surg. 2013 Jul;5(4):306–10.
Apte RS, Chen DS, Ferrara N. VEGF in Signaling and Disease: Beyond Discovery and Development. Cell. 2019 Mar 7;176(6):1248–64.
Kim MS, Han DH, Kwon OK, Oh CW, Han MH. Clinical characteristics of dural arteriovenous fistula. J Clin Neurosci. 2002 Mar;9(2):147–55.
Morsi RZ, Baskaran A, Thind S, Carrión-Penagos J, Desai H, Kothari SA, et al. Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series. Indian J Otolaryngol Head Neck Surg. 2024 Apr;76(2):1554–62.
Pal A, Blanzy J, Gómez KJR, Preul MC, Vernon BL. Liquid Embolic Agents for Endovascular Embolization: A Review. Gels. 2023 May 4;9(5):378.