Endovascular management of dural arteriovenous fistulae of the anterior condylar confluence.

Abstract

Introduction: Dural arteriovenous fistulae (dAVFs) can lead to subarachnoid hemorrhage and other devastating complications. A rare subtype of dAVFs is those located in the anterior condylar confluence adjacent to the hypoglossal canal. These dAVFs can be difficult to treat, with some electing to utilize endovascular approaches for these lesions. There is a need to further assess the safety and efficacy of this approach.

Case description: All patients that underwent endovascular treatment of dAVFs affecting the anterior condylar confluence at our center were included. Pre-treatment factors including anatomy and presentation were recorded, as were follow-up data including angiographic cure and clinical or technical complications. Three patients were included in this study. Presenting symptoms included ocular hyperemia, proptosis, auditory symptoms (whooshing, tinnitus), and Cranial Nerve 6 palsy. Both transarterial and transvenous embolization were employed in select cases, with Onyx HD-500 and coils both used as embolic materials. No clinical or technical complications were reported in these patients, and patients were asymptomatic at final follow-up without recurrence or regrowth of their dAVF.

Conclusions: Treatment of dAVFs located in the anterior condylar confluence can be achieved endovascularly using both transarterial and transvenous approaches.