A case of anterior condylar confluent dural arteriovenous fistula with an initial complaint of hypoglossal nerve palsy developing ocular symptoms after transarterial embolization: case report

Abstract

Objective: We report on a case of the right anterior condylar confluent (ACC) dural arteriovenous fistula (AVF) with unique clinical course.
Case presentation: A 57yearold man presented with pulsatile tinnitus and right hypoglossal nerve palsy. Cerebral angiography revealed right ACC dural AVF. Transarterial embolization was performed at first to avoid permanent hypoglossal nerve palsy after the treatment. One year after regression of symptoms following the initial treatment, the patient developed the right ocular symptoms due to an alteration of venous outflow. He underwent transvenous embolization using an approach via the intercavernous sinus from the contralateral inferior petrosal sinus with complete obliteration of the dural AVF with clinical cure.
Conclusion: Dural AVF involving ACC may recur with clinical symptoms similar to cavernous sinus dural AVF. Selection of a strategy based on the clinical and angiographic condition is extremely important. Contralateral approach can be a useful alternative in certain situations for the treatment of ACC dural AVF.