Lateral Tentorial Arcade

Basically, the above picture says it all.  Plus excellent name — Arcade.  Not artery.  We emphasize that the whole dura is a “tabula rasa” for arterial and venous channels.   The classic lateral tentorial arcade is a single vessel from MHT along the tentorium of the petrous ridge.  However, pathologic flow demand anywhere along this ridge will enlarge to visibility any number of arteries in the dura along the same conduit.  Its just a matter of resolution and technique.  Thinking of all dural vessels (and others) as preferred routes — indeed arcades — among many possibilities is probably best.   A sister example to this is the Marginal Tentorial Arcade.

Also very important to note that in shunts the petrous branches of the MMA will often contribute to the arcade as well — many examples below.   Since they are potentially associated with the facial nerve, healthy caution is helpful.

Here are some examples, from less to more complex

Old image — typical course (red) from MHT , sloping downward and posteriorly (the marginal tentorial usually slopes gently upward with the incisura).  Slip of flow along the sigmoid sinus (orange) shows the fistula

Frontal projection same case

Another example in a dural fistula

A more complex example — supply from MHT and MMA — via the petrous branches — converging on the arcade

More complex — sigmoid sinus fistula. The arcade is again fed in this case by the petrous branches of the MMA . Also participating are petroquamosal and occipital branches. Full case (superselective transvenous embo) is here

Stereos

One more example — another superselective transvenous embo case.  The arcade is fed by MHT and MMA — multiple channels from each

The common collector in wall of sigmoid sinus is white arrows

More complex sigmoid fistula — means more lateral tentorial vessels, in  this case mostly from the MMA…  Full case of this monstrosity here (superselective transvenous embolization cure)

Petrous Apex Fistula — in the immediate territory of the arcade — brings out the full angry might of these channels.  Myriad vessels along the ridge here – a whole carpet of them (outline)

See full case here