Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications

Abstract

Pulsatile tinnitus (PT) is often an initial presenting symptom of dural arteriovenous fistula (dAVF), but it may be overlooked or diagnosed late if not suspected on initial diagnostic work-up. Here, we assess anatomical features, treatment outcomes, and clinical implications of patients with PT due to dAVF. Of 220 patients who were diagnosed with dAVF between 2003 and 2014, 30 (13.6%) presented with only PT as their initial symptom. The transverse-sigmoid sinus (70.0%) was the most common site, followed by the hypoglossal canal (10.0%) and the middle cranial fossa (6.7%) on radiologic evaluation. Regarding venous drainage patterns, sinus or meningeal venous drainage pattern was the most common type (73.3%), followed by sinus drainage with a cortical venous reflux (26.7%). PT disappeared completely in 21 (80.8%) of 26 patients who underwent therapeutic intervention with transarterial embolization of the fistula, improved markedly in 3 (11.5%), and remained the same in 2 (7.7%). In conclusion, considering that PT may be the only initial symptom in more than 10% of dAVF, not only otolaryngologists but also neurologists and neurosurgeons should meticulously evaluate patients with PT. In most cases, PT originating from dAVF can be cured with transarterial embolization regardless of location and venous drainage pattern.

Importance of source images of time-of-flight magnetic resonance angiography in the diagnosis of low-flow dural arteriovenous fistulae after traumatic brain injury

“…While many cases were located in the middle fossa, a few cases were located in the posterior fossa, such as in our case. Generally, non-traumatic dAVF was reportedly associated with venous sinus thrombosis 6. However, in our case, no apparent thrombosis within the SS and TS was observed.…”

A Rare Case of Unilateral Pulsatil Tinnitus

“…However, the definitive diagnosis is given by arteriography, a procedure also performed towards a therapeutic management: the endovascular embolization. The appearance of knots in arteriography is pathognomonic of an arteriovenous malformation [4][5][6][7][8][9] .…”

Transcanal sound recordings as a screening tool in the clinical management of patients with pulsatile tinnitus: A pilot study of twenty patients with pulsatile tinnitus eligible for digital subtraction angiography

“…2 In more than 10% of the cases of patients with a dAVF, a pulsatile tinnitus is the only initial symptom. 3 A dAVF with cortical venous involvement (Borden 2 or 3) can, if left untreated, have an aggressive natural disease course with neurological sequelae and even death. 4 Therefore, patients with pulsatile tinnitus lacking a clear diagnose after non-invasive imaging should be referred for digital substraction angiography (DSA), which is considered as the gold standard for detection of dAVFs ( Figure 1).…”

“…They appear almost exclusively in males between the ages of 10 and 20 3. It is thought that JNA originates from the posterosuperior margin of the sphenopalatine foramen [1][2][3][4][5][6]. Due to their anatomical location near the skull base and their tendency towards local invasion, these tumours tend to originate extensive tissue destruction, bone remodelling 6 and frequent recurrence.…”