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

Abstract

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.

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

“…And then other alternative approaches are applied. 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 ).…”