Hagstrom Rory, Raz Eytan, Chung Charlotte, Save Akshay V, Khawaja Ayaz M, Ponchione Elizabeth, Frome Spencer, Sharashidze Vera, Baranoski Jacob, Rutledge Caleb W, Nossek Erez, Shapiro Maksim, Nelson Peter K, Riina Howard A
Departments of Neurosurgery, NYU Grossman School of Medicine, New York, New York.
Departments of Radiology, NYU Grossman School of Medicine, New York, New York.
J Neurosurg Case Lessons. 2024 Nov 18;8(21). doi: 10.3171/CASE24606.
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.
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.
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.
舌下神经管硬脑膜动静脉瘘（HCDAVF）是硬脑膜动静脉瘘（dAVF）中相对罕见的一种亚型，占所有dAVF的3%-5%。其复杂的血管和静脉结构易形成众多吻合支以及与包括后颅窝静脉窦和颅神经在内的附近解剖结构相连，这会使这些病变的诊断和治疗变得复杂。
作者描述了一名74岁男性HCDAVF病例，该患者出现搏动性耳鸣（PT）持续3个月，伴有明显疲劳、头痛和头晕。诊断性脑血管造影显示左侧HCDAVF，由咽升动脉双侧供血，瘘口位于左侧前髁静脉（ACV）水平。该病变符合Cognard和Borden I型dAVF。
作者介绍了一例通过同侧颈内静脉使用可脱卸弹簧圈进行经静脉栓塞（TVE）成功闭塞先前显示的至左侧ACV分流，并使患者的PT和头痛得到临床治愈且无并发症的病例。为成功治疗HCDAVF选择合适的治疗策略取决于对病变解剖特征的全面了解，即动脉供血支、静脉引流模式和瘘口位置。TVE是治疗HCDAVF的一种安全有效的治疗选择。https://thejns.org/doi/10.3171/CASE24606 。
