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Original research
Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae
  1. Matthew Thomas Crockett,
  2. Albert Ho Yuen Chiu,
  3. Tejinder P Singh,
  4. William McAuliffe,
  5. Timothy John Phillips
  1. Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  1. Correspondence to Dr Matthew Thomas Crockett, Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; crockettmt{at}gmail.com

Abstract

Background Hypoglossal canal dural arteriovenous fistulae (HC-dAVF) are a rare subtype of skull base fistulae involving the anterior condylar confluence or anterior condular vein within the hypoglossal canal. Transvenous coil embolization is a preferred treatment strategy, however delineation of fistula angio-architecture during workup and localization of microcatheter tip during embolization remain challenging on planar DSA. For this reason, our group have utilized intra-operative cone beam CT (CBCT) and selective cone beam CT angiography (sCBCTA) as adjuncts to planar DSA during workup and treatment. The purpose of this article is to present our experience in the treatment of HC-dAVF using transvenous coil embolization (TVCE) with cone beam CT assistance, describing our technique as well as presenting our angiographic and clinical outcomes.

Methods Ten patients with symptomatic HC-dAVF were treated using TVCE with intra-operative cone beam CT assistance. Prospectively collected data regarding clinical and angiographic results and complication rates was recorded and reviewed.

Results Complication-free fistula occlusion was achieved in our entire patient cohort. The dominant symptom of pulsatile tinnitus resolved in all 10 patients.

Conclusions This study demonstrates that TVCE with CBCT assistance is a highly effective treatment option for HC-dAVF, achieving complication-free fistula occlusion in our entire patient cohort. We have found low-dose sCBCTA and CBCT to be an extremely useful adjunct to planar DSA imaging during both workup and treatment of these rare fistulae.

  • fistula
  • vascular malformation
  • embolic
  • ct
  • ct angiography
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Footnotes

  • Contributors MTC; conception and design of study; acquisition, analysis, and interpretation of data; writing of manuscript. AHYC, TPC, WM; acquisition, analysis, and interpretation of data. TJP; acquisition, analysis, and interpretation of data, revision of manuscript and approval of final version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Western Australia Health GEKO committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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