Multiple Dural Arteriovenous Fistulas Manifesting as Progressive Otalgia and Tinnitus and Treated Using a Single Session of Endovascular Embolization

Figures & data

Figure 1 (A and B) Enhanced angiographic CT examination in and (C and D) maximum intensity projection technique showed a complex tangle of dilated and tortuous vessels of the right-sided temporoparietooccipital regions and posterior condylar area (arrowheads).

Figure 2 (A) Axial T2 weighted image demonstrates fine tortious dural vessels at the right parietooccipital and temporal region (arrowheads). (B and C) Susceptibly weighted image (SWI) showed engorged dural vessels with multifocal intraparenchymal hemorrhage in the right temporal and occipital area (arrows). (D) Arterial spin labeling (ASL) showed an increased blood pool in the right occipital and temporal region, resembling venous congestion.

Figure 3 (A) Lateral cerebral angiogram selectively through the left external carotid artery (arrowhead) showed Torcula dAVF (asterisk) and posterior condylar vein (arrow). (B and C) Cerebral angiogram lateral view and 3D reconstruction of the right external carotid artery injection respectively showed posterior condylar vein (arrow), lateral sinus dAVF (asterisk) and the left external carotid artery (arrowhead). (D) AP view cerebral angiogram through the left external carotid artery showed Torcula dAVF (arrowhead). (E) Three dimensional both ECA angiogram (fused image) visualizes Torcula dAVF, and lateral sinus dAVF (arrowheads).

Figure 4 (A) The selective roadmap of the lower skull part shows super-selection of paravertebral venous plexus reaching to posterior condylar vein dAVF (arrow). (B) Platinum coils were deployed at the posterior condylar vein dAVF (arrows). (C) The final run shows the total obscuring of posterior condylar vein AVF (asterisk). (D and E) Post-operative computed tomography images reveal complete coil material at the location of posterior Condylar vein dAVF, with embolic material obscuring the lateral sinus Davf (arrowheads).

Table 1 A Summary of Reported Cases of dAVFs Involving the Posterior Condylar Vein

Case	Age/Sex	Presentation	Feeding Arteries	Draining Vein	Treatment/Result
Maus V. 2016^Citation15	(*, F)	Tinnitus	Ascending pharyngeal artery, Vertebral artery	Suboccipital cavernous venous plexus, Sigmoid sinus and internal jugular vein	TVE/cured
Kiyosue H 2007^Citation16	(54y, M)	Tinnitus	Ascending pharyngeal artery, Vertebral artery, Occipital artery	Sigmoid sinus, Paravertebral veins	TVE/cured
Mondel PK 2014^Citation17	(43y, M)	SAH with intraventricular hemorrhage	Ascending pharyngeal artery, Vertebral artery, bilaterally	Single medullary bridging vein	TAE/cured
Shambanduram SS 2018^Citation18	(72 y, M)	Severe headache, vomiting and neck rigidity. SAH in the left cerebello-pontine angle cistern and bilateral lateral ventricles.	Posterior meningeal branch of the left V3 vertebral artery.	Ipsilateral lateral medullary pontine vein emptying into the anterior medullary-anterior pontomesencephalic longitudinal venous axis, and into the contralateral superior petrosal sinus via the petrosal vein	TAE/cured
Our case 2020	(67y, M)	Progressive right-sided tinnitus, dysarthria, and slurred motion	Proximal occipital branches, Ascending pharyngeal, Odontoid arch distribution	Deep cervical veins, Suboccipital venous plexus	TVE/cured

Note: *Not mentioned.

Abbreviations: M, male; F, female; y, year-old; SAH, subarachnoid hemorrhage; TVE, transvenous embolization; TAE, transarterial embolization.

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