Dural arteriovenous fistulas of the anterior condylar confluence involving the anterior condylar vein within the hypoglossal canal: Two case reports.

Abstract

Background: Dural arteriovenous fistulas (DAVFs) of the anterior condylar confluence (ACC) are rare vascular lesions at the skull base, often characterized by complex venous anatomy and variable clinical presentations. Their symptoms may overlap with those of cavernous sinus (CS) DAVFs, leading to potential misdiagnosis. Advanced imaging techniques and individualized treatment approaches are essential for accurate diagnosis and effective management.

Case description: We present two cases of ACC DAVFs successfully treated with transvenous embolization (TVE). The first case involved a patient with hypoglossal nerve palsy and non-specific headache. The second case presented with cranial nerve III palsy, proptosis, and diplopia due to retrograde venous drainage into the CS, along with hypoglossal nerve symptoms, including tongue stiffness and difficulty speaking. Both patients experienced complete resolution of symptoms following treatment.

Conclusion: ACC DAVFs are challenging to diagnose and treat due to their anatomical complexity and diverse presentations. These cases highlight the efficacy and safety of TVE as the preferred treatment, underscoring the critical role of advanced imaging and individualized management in achieving favorable outcomes.