Abstract
Objective: We present a case of dural arteriovenous fistulas (DAVFs) near the anterior condylar confluence (ACC) manifesting as pulsatile tinnitus, treated with transvenous coil embolization through an anastomosis between the left internal jugular vein and the vertebral venous plexus.
Case presentation: A 59-year-old male presented with pulsatile tinnitus. Cerebral angiography revealed left DAVFs near the ACC, fed by the left occipital artery, ascending pharyngeal artery, and meningeal branches of the vertebral artery, and drained by the lateral (LCV) and posterior condylar veins (PCV) into the suboccipital cavernous sinus (SCS), vertebral artery venous plexus, and the deep cervical vein. An anastomosis between the left internal jugular vein and the vertebral venous plexus was also revealed at the second cervical level. Embolization was performed with coils inserted from the anastomosis through the SCS into the LCV and PCV. The DAVFs disappeared immediately after treatment and the pulsatile tinnitus also disappeared a few days later.
Conclusion: The anastomosis between the internal jugular vein and the vertebral venous plexus could provide an alternative route for embolization of dural arteriovenous fistulas near the anterior condylar confluence.
