Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

Crockett, Matthew Thomas; Chiu, Albert; Singh, Tejinder; McAuliffe, William; Phillips, Timothy J

doi:10.1136/neurintsurg-2018-014115

Cited by 8 publications

(8 citation statements)

References 8 publications

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“…5,11 Selective shunted pouch embolization is especially useful when the shunted pouch is located in the jugular tubercle venous complex to avoid hypoglossal nerve palsy. For such a specific shunted pouch identification, preoperative MPR 3DRA and intraoperative CBCT are useful as reported in earlier studies 1,5,10,12–14 and as seen in the present case. Previous reports demonstrated diagnostic usefulness of the intraoperative CBCT to confirm the location of the shunted pouch.…”

Section: Discussionsupporting

confidence: 70%

Cone-beam CT-assisted microcatheter tip placement at the shunted pouch entry zone: A technical note for anterior condylar arteriovenous fistula

et al. 2022

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Accurate microcatheter placement for anterior condylar arteriovenous fistula (AVF) enables selective transvenous embolization (TVE) and helps to avoid hypoglossal nerve palsy. Anterior condylar AVF has a shunted pouch within the condylar vascular and osseous structures. Detailed anatomical comprehension of the shunted pouch is essential, in addition, we believe that it is important to have a strategy for where in the shunted pouch to start filling with coils. Specifically, we consider that it is important to structurally understand the more upstream location (arterial side) within the shunted pouch (called “ shunted pouch entry zone”), guide the microcatheter there, and embolize from that site. Although several studies have discussed the usefulness of intraoperative cone-beam computed tomography (CBCT) for treating anterior condylar AVF, there are no studies which have mentioned the importance of microcatheter position before coil embolization in selective TVE as in this study. Intraoperative localization of the shunted pouch entry zone is often difficult. Herein, the authors report that cone-beam computed tomography (CBCT) can assist accurate microcatheter tip placement at the shunted pouch entry zone before staring embolization. This is the novel application of intraoperative CBCT to treat anterior condylar AVF successfully treated with precise and selective TVE.

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Section: Discussionsupporting

confidence: 70%

Cone-beam CT-assisted microcatheter tip placement at the shunted pouch entry zone: A technical note for anterior condylar arteriovenous fistula

et al. 2022

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“…HCDAVF is a rare subtype of dural arteriovenous fistulas (DAVF) that accounts for less than 5% of the total intracranial DAVF ( 4 , 5 ). Spittau et al classified the dominant vein drainage patterns of HCDAVFs into three categories according to different clinical presentations ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…According to Spittau et al the clinical cure rate of TVE is 91%, and the permanent morbidity is 2.9%. The most common route is via the internal jugular vein ( 3 , 4 ). TVE embolization materials include coils and liquid embolizers.…”

Section: Discussionmentioning

confidence: 99%

“…The intravenous balloon-assisted technique allowed onyx to penetrate better and prevented onyx from dispersing to the IJV ( 10 ). Besides, Crockett et al reported that intraoperative selective cone-beam CT angiography (CBCTA) and intraoperative cone-beam CT (CBCT) were useful adjunct tools for planar DSA during the examination and intravenous coil embolization of HCDAVFs ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

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The combined transarterial and transvenous onyx embolization of dural arteriovenous fistula of hypoglossal canal via the external jugular vein and facial vein: A case report

Yang

Ren

et al. 2023

Front. Surg.

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Dural arteriovenous fistulas of the hypoglossal canal (HCDAVFs) involving the anterior condylar confluence (ACC) and anterior condylar vein (ACV) are infrequent. Although transvenous embolization through the internal jugular vein (IJV) is the preferred treatment option for type I and II fistulas, it can be difficult if the IJV is unavailable. Here we report a rare case of HCDAVF in which the most common transvenous embolization access via IJV was not available. The patient underwent transarterial and transvenous onyx embolization. Transarterial embolization (TAE) aimed at controlling the arterial inflow and subsequently TVE was performed via the external jugular vein (EJV), the facial vein, the ophthalmic vein, the cavernous sinus, ACC, and ultimately to the fistula pouch. Complete obliteration of the HCDAVF was achieved without complications. We suggest that transvenous embolization (TVE) via the EJV and the facial vein can be effective in cases where trans-IJV is not possible.

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“…Intraoperative CBCT may confirm coil positioning inside the hypoglossal canal before detachment. 11 However, HC-DAVFs with no venous access may require transarterial embolization or surgery. 4 Transarterial embolization carries a significant risk of cranial nerve injury and potential non-target embolization.…”

Section: Discussionmentioning

confidence: 99%

Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach

et al. 2020

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Hypoglossal canal dural arteriovenous fistulas (HC-DAVF) involve the anterior condylar vein (ACV) and anterior condylar confluence (ACC). They often present with tinnitus, bruit, and hypoglossal nerve palsy. The most common treatment in HC-DAVFs is transvenous embolization using coils and the most direct transvenous route is the trans-internal jugular vein access. When this approach is not feasible, a treatment attempt is possible through alternative routes. We report 2 patients with DAVFs involving the anterior condylar confluence. The first patient presented with pulsatile tinnitus and hypoglossal nerve palsy, and was treated by a standard transjugular approach. The second patient presented with pulse-synchronous bruit. Following an unsuccessful attempt of the transjugular approach, the fistulous point was reached via the deep cervical vein and complete occlusion was achieved by coil deployment. Both patients had complete regression of symptoms. Endovascular therapy is the elective treatment for HC-DAVFs and the transjugular approach is the most commonly used. The deep cervical vein (DCV) can be an alternative transvenous route when the transjugular approach fails.

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Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

Cited by 8 publications

References 8 publications

Cone-beam CT-assisted microcatheter tip placement at the shunted pouch entry zone: A technical note for anterior condylar arteriovenous fistula

Cone-beam CT-assisted microcatheter tip placement at the shunted pouch entry zone: A technical note for anterior condylar arteriovenous fistula

The combined transarterial and transvenous onyx embolization of dural arteriovenous fistula of hypoglossal canal via the external jugular vein and facial vein: A case report

Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach

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