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Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

  • Interventional Neuroradiology
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Abstract

Introduction

We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder.

Methods

Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment.

Results

Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a “magic wand” appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n = 2), transvenous embolization (TVE; n = 2), and TAE/TVE (n = 1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking.

Conclusion

The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction.

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References

  1. Nakahara I, Pile-Spellman J, Hacein-Bey L, Crowell RM, Gress D (1993) Posterior fossa dural arteriovenous fistula with isolated sinus segment. No To Shinkei 45:703–709

    PubMed  CAS  Google Scholar 

  2. Bavinzski G, Richling B, Killer M, Gruber A, Levy D (1996) Evolution of different therapeutic strategies in the treatment of cranial dural arteriovenous fistulas – report of 30 cases. Acta Neurochir (Wien) 138:132–138

    Article  CAS  Google Scholar 

  3. Olteanu-Nerbe V, Uhl E, Steiger HJ, Yousry T, Reulen HJ (1997) Dural arteriovenous fistulas including the transverse and sigmoid sinuses: results of treatment in 30 cases. Acta Neurochir (Wien) 139:307–318

    Article  CAS  Google Scholar 

  4. Malek AM, Halbach VV, Dowd CF, Higashida RT (1998) Diagnosis and treatment of dural arteriovenous fistulas. Neuroimaging Clin N Am 8:445–468

    PubMed  CAS  Google Scholar 

  5. Duffau H, Lopes M, Janosevic V, Sichez JP, Faillot T, Capelle L, Ismail M, Bitar A, Arthuis F, Fohanno D (1999) Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg 90:78–84

    PubMed  CAS  Google Scholar 

  6. Kim MS, Han DH, Kwon OK, Oh CW, Han MH (2002) Clinical characteristics of dural arteriovenous fistula. J Clin Neurosci 9:147–155

    Article  PubMed  Google Scholar 

  7. Chung SJ, Kim JS, Kim JC, Lee SK, Kwon SU, Lee MC, Suh DC (2002) Intracranial dural arteriovenous fistulas: analysis of 60 patients. Cerebrovasc Dis 13:79–88

    Article  PubMed  Google Scholar 

  8. Satomi J, van Dijk JM, Terbrugge KG, Willinsky RA, Wallace MC (2002) Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. J Neurosurg 97:767–770

    PubMed  Google Scholar 

  9. Klisch J, Huppertz HJ, Spetzger U, Hetzel A, Seeger W, Schumacher M (2003) Transvenous treatment of carotid cavernous and dural arteriovenous fistulae: results for 31 patients and review of the literature. Neurosurgery 53:836–856

    Article  PubMed  Google Scholar 

  10. Caragine LP, Halbach VV, Dowd CF, Ng PP, Higashida RT (2003) Parallel venous channel as the recipient pouch in transverse/sigmoid sinus dural fistulae. Neurosurgery 53:1261–1266

    Article  PubMed  Google Scholar 

  11. Wen HT, Rhoton AL, Katsuta T, de Oliveira E (1997) Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87:555–585

    PubMed  CAS  Google Scholar 

  12. San Millan Ruiz D, Gailloud P, Rufenacht DA, Delavelle J, Henry F, Fasel JH (2002) The craniocervical venous system in relation to cerebral venous drainage. AJNR Am J Neuroradiol 23:1500–1508

    PubMed  Google Scholar 

  13. Mitsuhashi Y, Nishio A, Kawahara S, Ichinose T, Yamauchi S, Naruse H, Matsuoka Y, Ohata K, Hara M (2007) Morphologic evaluation of the caudal end of the inferior petrosal sinus using 3D rotational venography. AJNR Am J Neuroradiol 28:1179–1184

    Article  PubMed  CAS  Google Scholar 

  14. Satoh K, Satomi J, Nakajima N, Matsubara S, Nagahiro S (2001) Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases. J Neurosurg 94:422–426

    PubMed  CAS  Google Scholar 

  15. Jamous MA, Satoh K, Satomi J, Matsubara S, Nakajima N, Uno M, Nagahiro S (2004) Detection of enlarged cortical vein by magnetic resonance imaging contributes to early diagnosis and better outcome for patients with anterior cranial fossa dural arteriovenous fistula. Neurol Med Chir (Tokyo) 44:516–520

    Article  Google Scholar 

  16. Satomi J, Satoh K, Matsubara S, Nakajima N, Nagahiro S (2005) Angiographic changes in venous drainage of cavernous sinus dural arteriovenous fistulae after palliative transarterial embolization or observational management: a proposed stage classification. Neurosurgery 56:494–502

    Article  PubMed  Google Scholar 

  17. Hanaoka M, Satoh K, Satomi J, Matsubara S, Nagahiro S, Takimoto O, Ohbayashi M (2006) Microcatheter pull-up technique in the transvenous embolization of an isolated sinus dural arteriovenous fistula. Technical note. J Neurosurg 104:974–977

    Article  PubMed  Google Scholar 

  18. Newton TH, Weidner W, Greitz T (1968) Dural arteriovenous malformation in the posterior fossa. Radiology 90:27–35

    PubMed  CAS  Google Scholar 

  19. Pierot L, Chiras J, Meder JF, Rose M, Rivierez M, Marsault C (1992) Dural arteriovenous fistulas of the posterior fossa draining into subarachnoid veins. AJNR Am J Neuroradiol 13:315–323

    PubMed  CAS  Google Scholar 

  20. Barnwell SL, Halbach VV, Dowd CF (1990) Dural arteriovenous fistulas involving the inferior petrosal sinus: angiographic findings in six patients. AJNR Am J Neuroradiol 11:511–516

    PubMed  CAS  Google Scholar 

  21. McDougall CG, Halbach VV, Dowd CF (1997) Dural arteriovenous fistulas of the marginal sinus. AJNR Am J Neuroradiol 18:1565–1572

    PubMed  CAS  Google Scholar 

  22. Ernst R, Bulas R, Tomsick T (1999) Three cases of dural arteriovenous fistula of the anterior condylar vein within the hypoglossal canal. AJNR Am J Neuroradiol 1120:2016–2020

    Google Scholar 

  23. Kiyosue H, Tanoue S, Okahara M, Mori M, Mori H (2001) Ocular symptoms associated with a dural arteriovenous fistula involving the hypoglossal canal: selective transvenous coil embolization. J Neurosurg 94:630–632

    PubMed  CAS  Google Scholar 

  24. Komiyama M, Ishiguro T, Matsuzaka Y, Yasui T (2002) Intense pulse-synchronous tinnitus caused by dural arteriovenous fistula at the hypoglossal canal. No To Shinkei 54:830–831

    PubMed  Google Scholar 

  25. Arai Y, Ishii H, Handa Y, Ueda Y, Shirasaki N, Nozaki J, Kubota T (2004) Dural arteriovenous fistula within the hypoglossal canal successfully treated by transvenous embolization. Case report. Interv Neuroradiol 10:59–62

    Google Scholar 

  26. Tanoue S, Goto K, Oota S (2005) Endovascular treatment for dural arteriovenous fistula of the anterior condylar vein with unusual venous drainage: report of two cases. AJNR Am J Neuroradiol 26:1955–1959

    PubMed  Google Scholar 

  27. Combarros O, Alvarez de Arcaya A, Berciano J (1998) Isolated unilateral hypoglossal nerve palsy: nine cases. J Neurol 245:98–100

    Article  PubMed  CAS  Google Scholar 

  28. Blomquist MH, Barr JD, Hurst RW (1998) Isolated unilateral hypoglossal neuropathy caused by dural arteriovenous fistula. AJNR Am J Neuroradiol 19:951–953

    PubMed  CAS  Google Scholar 

  29. Friedman JA, Pollock BE, Nichols DA, Gorman DA, Foote RL, Stafford SL (2001) Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. J Neurosurg 94:886–891

    Article  PubMed  CAS  Google Scholar 

  30. Tomak PR, Cloft HJ, Kaga A, Cawley CM, Dion J, Barrow DL (2003) Evolution of the management of tentorial dural arteriovenous malformations. Neurosurgery 52:750–760

    Article  PubMed  Google Scholar 

  31. Pan HC, Sun MH, Yang DY, Wang YC, Lee SD, Chen WH, Chen CC (2005) Multidisciplinary treatment of cavernous sinus dural arteriovenous fistulae with radiosurgery and embolization. J Clin Neurosci 12:744–749

    Article  PubMed  Google Scholar 

  32. Koebbe CJ, Singhal D, Sheehan J, Flickinger JC, Horowitz M, Kondziolka D, Lunsford LD (2005) Radiosurgery for dural arteriovenous fistulas. Surg Neurol 64:392–398

    Article  PubMed  Google Scholar 

  33. Soderman M, Edner G, Ericson K, Karlsson B, Rahn T, Ulfarsson E, Andersson T (2006) Gamma knife surgery for dural arteriovenous shunts: 25 years of experience. J Neurosurg 104:867–875

    Article  PubMed  Google Scholar 

  34. Pan HC, Sheehan J, Huang CF, Yang DY (2007) Two consecutive dural arteriovenous fistulae in a child: a case report of successful treatment with gamma knife radiosurgery. Childs Nerv Syst 23:1185–1190

    Article  PubMed  Google Scholar 

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Tokushima, Tokushima, Japan

    Shinji Manabe, Koichi Satoh, Shunji Matsubara, Junichiro Satomi, Mami Hanaoka & Shinji Nagahiro

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  1. Shinji Manabe
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  2. Koichi Satoh
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  3. Shunji Matsubara
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  4. Junichiro Satomi
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  6. Shinji Nagahiro
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Correspondence to Shinji Manabe.

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Manabe, S., Satoh, K., Matsubara, S. et al. Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases. Neuroradiology 50, 715–721 (2008). https://doi.org/10.1007/s00234-008-0393-7

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