J Cerebrovasc Endovasc Neurosurg.  2022 Jun;24(2):166-171. 10.7461/jcen.2021.E2021.08.004.

Transvenous coil embolization of hypoglossal canal dural arteriovenous fistula using detachable coils: A case report

• Kye SM
• Ahn JH
• Lee HS
• Kim JH
• Oh JK
• Song JH
• Chang IB

• KMID: 2531660
• DOI: http://doi.org/10.7461/jcen.2021.E2021.08.004

Abstract

The hypoglossal canal (HC) is an unusual location of the posterior fossa dural arteriovenous fistula (AVF), which usually occurs in the transverse or sigmoid sinus. Herein, we report a case of HC dural AVF successfully treated with transvenous coil embolization using detachable coils in a 68-year-old woman who presented with headache and left pulsatile tinnitus for 2 months. Brain magnetic resonance imaging (MRI) and cerebral angiography revealed left HC dural AVF. The pulsatile bruit disappeared immediately after the procedure. Follow-up MRI showed complete disappearance of the fistula. Precise localization of the fistula through careful consideration of the anatomy and transvenous coil embolization using a detachable coil can facilitate the treatment for HC dural AVF.

Keyword

Hypoglossal canal; Dural Arteriovenous Fistula; Coil Embolization

Figure

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  Fig. 1. Magnetic resonance angiography shows abnormal signal hyperintensity around the left hypoglossal canal (the “magic wand appearance”) (arrow) (A, B). A bone imaging computed tomography shows bone erosion and expansion of left hypoglossal canal (arrow) (C).

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  Fig. 2. Cerebral angiography reveals a dural arteriovenous fistula in the anterior condylar vein within the left hypoglossal canal (HC) fed by neuromeningeal branches of the bilatreral ascending pharyngeal artery (APA), occipital artery (A, B, C) and vertebral artery (D), which drained into internal jugular vein (IJV), cavernous sinus (CS) through inferior petrosal sinus (IPS), and vertebral venous plexus (VVP). Schematic illustration shows detailed anatomy of dural arteriovenous fistula (E).

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  Fig. 3. Microcatheter angiography demonstrated dilated venous pouch connected with vertebral venous plexus (arrow) and inferior petrosal sinus (arrowhead) (A). Final angiography showed complete occlusion of dural arteriovenous fistula and contrast stagnation around the hypoglossal canal (arrow) (B, C). CT shows coil mass in the hypoglossal canal (D). CT, computed tomography.

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  Fig. 4. Follow-up magnetic resonance image (A), and magnetic resonance angiography (B) showed complete disappearance of dural arteriovenous fisula.

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