Unique percutaneous direct puncture technique for occlusion of a hypoglossal canal dural arteriovenous fistula

Diaz, Orlando M.; Toledo, Maria; Roehm, John O.F.; Klucznik, Richard P.; Chinnadurai, Ponraj; Lopez, Gloria Viviana; Britz, Gavin W.

doi:10.1136/neurintsurg-2018-013845

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…At present, the main treatment methods are TAE, TVE, surgery, and radiotherapy. TAE carries a significant risk of inferior cranial nerve palsy and embolic stroke because the neurovessels of the inferior cranial nerves (IX-XII) are derived from the neuromeningeal trunk of the ascending pharyngeal artery (6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

“…Dahl et al reported a case of successful treatment of HCDAVF by intravenous coil embolization through the deep cervical vein as an alternative access to the ACC after the failure of the trans-IJV approach ( 11 ). Diaz et al reported a case of HCDAVF in which, after embolization and surgical failure, the anterior condylar vein was punctured percutaneously at the hypoglossal foramina and occluded with onyx after placing two anchor coils ( 6 ). Júnior et al reported a case of HCDAVF in which the ACC was occluded by direct puncture of the cavernous sinus after transvenous access was unavailable ( 12 ).…”

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Given the proximity of the venous pouch to the posterior wall of the sphenoid sinus, we determined that a transsphenoidal approach would enable us to directly access the venous pouch for Onyx embolization. Direct puncture and embolization of the venous pouch has been successfully described for dAVFs of the skull base such as the hypoglossal canal, 14 but not via an endoscopic endonasal transsphenoidal approach. Our ability to perform this ap- proach was dependent on a full understanding of the venous outflow of the fistula and the availability of a hybrid operating room.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal transsphenoidal direct access and Onyx embolization of a dural arteriovenous fistula mimicking a carotid-cavernous fistula: case report

Karas¹,

North²,

Srinivasan³

et al. 2021

Journal of Neurosurgery

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The classic presentation of a carotid-cavernous fistula (CCF) is unilateral painful proptosis, chemosis, and vision loss. Just as the goal of treatment for a dural arteriovenous fistula (dAVF) is obliteration of the entire fistulous connection and the proximal draining vein, the modern treatment of CCF is endovascular occlusion of the cavernous sinus via a transvenous or transarterial route. Here, the authors present the case of a woman with a paracavernous dAVF mimicking the clinical and radiographic presentation of a CCF. Without any endovascular route available to access the fistulous connection and venous drainage, the authors devised a novel direct hybrid approach by performing an endoscopic endonasal transsphenoidal direct puncture and Onyx embolization of the fistula.

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“…4 Transarterial embolization carries a significant risk of cranial nerve injury and potential non-target embolization. 3 , 4 Although direct puncture of the hypoglossal canal may be feasible, 12 alternative venous routes should be considered and exhausted before performing more aggressive procedures.…”

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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Unique percutaneous direct puncture technique for occlusion of a hypoglossal canal dural arteriovenous fistula

Abstract: With guidance and imaging provided by CBCT and syngo iGuide navigational software, an otherwise untreatable DAVF was successfully embolized and obliterated by an aggressive unique percutaneous trans-cranial needle puncture of the dominant outflow vein in the hypoglossal canal.

Cited by 10 publications

References 26 publications

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

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

Endoscopic endonasal transsphenoidal direct access and Onyx embolization of a dural arteriovenous fistula mimicking a carotid-cavernous fistula: case report

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

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