拍動性耳鳴を契機に診断された高位頸静脈球に硬膜動静脈瘻を合併した1例

抄録

We report the case of a patient with a dural arteriovenous fistula in a high jugular bulb. A 33-year-old woman visited our hospital with a one-month history of right pulsatile tinnitus. Her right eardrum was dark-red in color, with swelling of the small blood vessels. A pure tone audiometry showed normal hearing. Temporal-bone CT revealed a high jugular bulb on the right side, which was then considered as the cause of the pulsatile tinnitus. Since the tinnitus did not improve with the conservative treatment, a head MRA/contrast-enhanced MRI examination was performed for further evaluation. The MRI findings suggested the presence of a dural arteriovenous fistula in the expanded right jugular bulb. Angiography was performed by the brain surgeon, which revealed a dural arteriovenous fistula at the right transverse-sigmoid sinus fed by a large number of branches derived from the right external carotid artery, internal carotid artery, and vertebral artery. There was no stenosis in the right transverse-sigmoid sinus, and it functioned as a normal venous return pathway. Based on the above, the patient was diagnosed as having a Borden Type 1 arteriovenous fistula, and it was decided to follow up the patient. Because a high jugular bulb could be associated with other vascular abnormalities and temporal bone tumors, head MRI/MRA is useful for the diagnosis. Dural arteriovenous fistulas may show progression, and strict follow-up is recommended even in the absence of any proactive treatment.