Management of a rare case of posterior condylar canal dural arteriovenous fistula presenting with subarachnoid haemorrhage: A case report and review of literature

Abstract

<jats:p> Posterior condylar canal dural arteriovenous fistula (PCC dAVF) is a rare entity with only three cases having been reported so far in the English literature. We describe the clinical presentation, imaging, and endovascular management of an elderly man with left PCC dAVF presenting with subarachnoid haemorrhage (SAH). Endovascular management of such cases requires thorough understanding of the vascular anatomy around the craniovertebral junction (CVJ) and variable bridging vein draining patterns. The fistula in our case was fed by the posterior meningeal branch of the left vertebral artery and was draining through a dilated and tortuous medullary bridging vein into the antero-lateral pontomedullary venous system. Transarterial glue embolisation was performed with complete exclusion of the fistula and venous pouches. The patient developed intractable hiccough and left-sided facial pain on the second post-procedural day, and MRI showed focal diffusion restriction in the left dorso-lateral medulla. He recovered completely after a short course of steroids. </jats:p>

Dural arteriovenous fistula of the lateral foramen magnum region: A review

“…26,47 PCC DAVFs may also rarely form a long, tortuous bridging vein into the brainstem venous system. 26,48 This abnormal vein may represent an embryological developmental relic. 56,57…”

“…26,59,61 For instance, in PCC DAVFs with vein drainage that bridges to the brainstem venous system, a long and tortuous draining vein may often be present with multiple venous pouches and stenosis, making it prone to rupture. 26,48 In a study by McDougall et al, three of 14 MS DAVF cases had subarachnoid and intracerebellar hemorrhage. 49…”

“…In addition, the AMA, PMA, and OA can also feed PCC DAVFs. 5,26,47,48 Rarely, the dorsal meningeal artery of the ICA and, for example, the dural branches of the cervical VA can be involved in PCC DAVFs. 5,26,47 Draining vein.…”

“…Performing CTA in the venous phase can reveal increased vascularization around the lateral FM region. 26,47,48 In addition, an oblique reconstruction of a CTA can show the bone structure and enhance the clinician's understanding of the DAVF, which can be very helpful. 41 Selective intra-arterial injection CTA is more useful for confirming the precise anatomy of the DAVF and developing a treatment strategy.…”

<p>Multiple Dural Arteriovenous Fistulas Manifesting as Progressive Otalgia and Tinnitus and Treated Using a Single Session of Endovascular Embolization</p>

“…Moreover, ONYX has unique physical properties, which facilitates prolonged injections that can be better controlled, along with a more predictable penetration and higher cure rate compared to other agents. 13,18,19 We used transarterial embolization using PVA particles to transiently occlude the torcular dAVF through decrease the shunt flow and thereafter temporarily resolve the patient's symptoms. Although it is not recommended to use only PVA particles, it can be used in conjunction with other procedures such as irradiation, surgery or transvenous embolization.…”