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

Abstract

Background Multiple cranial dural arteriovenous fistulas (dAVFs) are considered to be an uncommon vascular condition. dAVFs usually manifest with vague symptoms, which are related to the site of occurrence of the lesion and present with complex angio-architectural features, which in turn can render treatment procedures difficult. Appropriate treatment that aims to reduce the risk of intracranial bleeding and manage the patient’s symptoms requires a multidisciplinary approach. Case Presentation The patient was a 62-year-old man who developed symptoms of progressive right-sided otalgia and tinnitus. Cross-sectional imaging revealed long-standing venous congestion with intracranial hemorrhage in the right parieto-occipital region. Moreover, cerebral angiography demonstrated multiple complex dAVFs at the right transverse sinus-sigmoid sinus (TS-SS) junction, right posterior condylar confluence (PCC), and torcula. Treatment consisted of one session of endovascular treatment, in which transarterial Onyx embolization was used to treat the dVAF at the right TS-SS junction, transvenous coil embolization for the dVAF at the right PCC, and particle embolization for both occipital arteries feeding the torcular dAVF. Postoperative improvement with favorable clinical outcomes was observed at the patient’s last follow-up visit. Conclusion Multiple cranial dAVFs are an uncommon vascular lesion, which can present with unusual symptoms such as otalgia. Moreover, a single session of endovascular therapy can treat this lesion, ie, it can improve the patient’s symptoms and provide a beneficial long-term outcome.

Posterior condylar canal dural arteriovenous fistula as a rare cause of glossopharyngeal neuralgia: A case report

“…A few cases of PCC dAVF have been reported in the literature 3–8 . PCC dAVF is mainly supplied by the neuromeningeal division of the ascending pharyngeal artery.…”

“…5,10,14 There are various clinical presentations of PCC dAVF depending on the morphology of the fistular flow drainage, the size of the drain, the occlusion and the thrombosis caused by PCV, ACC, and the surrounding complex venous system. 4,9 The common symptoms of PCC dAVF are pulse-synchronous tinnitus and pulsatile bruit, which manifest as venous shunting to the inner ear inside the temporal bone. 4,5,7 There are also risks of intracranial hemorrhage.…”

“…It is also supplied by various arteries, such as the transmastoid branches of the occipital artery, and the meningeal vertebral artery branch 9,10 . The feeders are connected by the PCV, ACC, and ACV in the ventrolateral region of the hypoglossal canals, and the formation of the fistulous drainage is drained through the suboccipital cavernous venous plexus, sigmoid sinus, inferior petrosal sinus, jugular bulb, and internal jugular vein 4,11,12 . A rich venous network is formed around the condylar veins, forming a complex venous drainage pattern 13 …”

“…3 If dAVF results from abnormal connection between arteries and veins in the PCC, the usual symptoms are tinnitus and bruit. 4 We demonstrate a patient who presented with glossopharyngeal neuralgia due to dAVF involving the PCC. To the best of our knowledge, this is the first report of glossopharyngeal neuralgia caused by dAVF.…”

“…The posterior condylar canal (PCC) is a small bony canal located near the occipital condyle and may be involved in causing dAVFs 3 . If dAVF results from abnormal connection between arteries and veins in the PCC, the usual symptoms are tinnitus and bruit 4 …”