Transvenous Embolization with Detachable Coils for a Hypoglossal Canal Dural Arteriovenous Fistula: Illustrative Case

Overview

Journal J Neurosurg Case Lessons

Specialty Neurology

Date 2024 Nov 18

PMID 39556806

Authors

Rory Hagstrom

Eytan Raz

Charlotte Chung

Akshay V Save

Ayaz M Khawaja

Elizabeth Ponchione

Spencer Frome

Vera Sharashidze

Jacob Baranoski

Caleb W Rutledge

Erez Nossek

Maksim Shapiro

Peter K Nelson

Howard A Riina

Affiliations

Soon will be listed here.

Abstract

Background: Hypoglossal canal dural arteriovenous fistulas (HCDAVFs) are a relatively rare subtype of dural arteriovenous fistula (dAVF), representing 3%-5% of all dAVFs. The complex angio- and venous architecture predisposed to numerous anastomoses and nearby anatomical structures, including the posterior fossa sinuses and cranial nerves, can complicate both the diagnosis and treatment of these lesions.

Observations: The authors describe the case of HCDAVF in a 74-year-old male who presented with pulsatile tinnitus (PT) lasting 3 months and significant fatigue, headaches, and dizziness. Diagnostic cerebral angiography demonstrated a left-sided HCDAVF with bilateral supply from the ascending pharyngeal arteries and fistulous connection at the level of the left anterior condylar vein (ACV). This lesion was consistent with a Cognard and Borden type I dAVF.

Lessons: The authors present a case in which transvenous embolization (TVE) with detachable coils via the ipsilateral internal jugular vein successfully occluded the previously visualized shunt to the left ACV and provided a clinical cure for the patient's PT and headaches without complication. Selecting the appropriate treatment strategy for the successful treatment of HCDAVFs is predicated on a comprehensive understanding of the anatomical features of the lesion, namely arterial feeders, venous drainage pattern, and location of the fistulous connection. TVE is a safe and efficacious treatment option for HCDAVFs. https://thejns.org/doi/10.3171/CASE24606.

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