2012 年 6 巻 1 号 p. 25-31
Objective: We report a case of hearing disturbance occurring as a rare complication of transvenous embolization of a dural arteriovenous fistula (AVF) involving the anterior condylar confluence (ACC).
Case presentation: A 61-year-old man presented with hearing disturbance after transvenous embolization of a dural AVF involving the ACC. The manifestations of the dural AVF were left ocular symptoms such as conjunctival injection, chemosis, and diplopia. An angiogram located the fistula in the left ACC. And the ACC dural AVF was supplied mainly by the left ascending pharyngeal artery and drained from the ACC into the left inferior petrosal sinus, cavernous sinus, and superior ophthalmic vein retrogradely. It had no other drainage pathway angiographically. We attempted but failed to advance a microcatheter into the fistula at the ACC by the transvenous approach. Therefore we inserted the microcatheter into the left inferior petrosal sinus (IPS) and occluded the left IPS (the only available drainage route from the ACC) with platinum detachable coils. The final angiogram revealed almost no AVF remained. Soon thereafter left ocular symptoms improved, however, a left neurosensory hearing disturbance appeared 3 days later. The hearing disturbance was treated with steroid therapy and systemic heparinization immediately but was unresponsive to this treatment.
Conclusion: The hearing disturbance may be due to venous circulatory failure of the inner ear after occlusion of the IPS. The fistula, and not the IPS, should be occluded in the treatment of ACC dural AVF to avoid hearing complications.
