Maekawa Hidetsugu, Lindgren Antti, Krings Timo
Department of Neurosurgery, Nara Prefecture General Medical Center, Nara, Japan
Division of Interventional Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
J Neurointerv Surg. 2025 Feb 14;17(3):272-276. doi: 10.1136/jnis-2024-021495.
Posterior condylar canal dural arteriovenous fistulas (dAVFs) are extremely rare.
We report a case series and literature review of posterior condylar canal dAVFs and discuss similarities and differences between posterior condylar and hypoglossal canal dAVFs with respect to the related vascular anatomy, angioarchitecture of the fistula, presentation, and treatment.
Four cases of posterior condylar canal dAVF were identified at our institutions and six cases were identified in the literature. Posterior condylar canal dAVFs were predominantly frequent in relatively young women. All patients presented with pulsatile tinnitus. There was no history of hemorrhage as there was no cortical venous reflux. This is different from hypoglossal canal dAVFs which can present with myelopathy or hemorrhage from cortical venous reflux. Transvenous embolization was safe and eliminated the symptoms. Palliative transarterial embolization can be an option to mitigate the symptoms, although there is a potential risk of cranial nerve palsy or lateral medullary stroke.
Posterior condylar canal dAVFs are generally benign lesions. However, intolerable tinnitus may require intervention. Transvenous embolization is effective and safe.
髁后管硬脑膜动静脉瘘（dAVFs）极为罕见。
我们报告了一组髁后管dAVFs病例系列并进行文献综述，讨论髁后管与舌下神经管dAVFs在相关血管解剖、瘘的血管构筑、临床表现及治疗方面的异同。
我们机构确诊了4例髁后管dAVF，文献中发现6例。髁后管dAVFs在相对年轻女性中更为常见。所有患者均表现为搏动性耳鸣。由于不存在皮质静脉反流，所以无出血史。这与舌下神经管dAVFs不同，后者可表现为脊髓病或因皮质静脉反流导致出血。经静脉栓塞术安全且消除了症状。姑息性经动脉栓塞术可作为缓解症状的一种选择，尽管存在颅神经麻痹或延髓外侧卒中的潜在风险。
髁后管dAVFs通常为良性病变。然而，难以忍受的耳鸣可能需要干预。经静脉栓塞术有效且安全。
