Balloon-assisted coil embolization for anterior condylar confluent dural arteriovenous fistula

Abstract

Anterior condylar confluent dural arteriovenous fistula (ACC DAVF) is relatively rare. We present five cases of ACC DAVF. From March 2011 to August 2014 we treated six lesions in five cases of ACC DAVF. The mean age was 65.6 years and all cases were male. The lesions were 2 cases of right, 2 cases of left, and one case of bilateral lesions. All cases presented with tinnitus. The feeding arteries were the ascending pharyngeal artery in 5 cases, the occipital artery in 2 cases, and the vertebral artery in 4 cases. Venous pouch was revealed in 4 cases, and the mean pouch size was 9.8 mm in diameter. Retrograde venous flow was evident in 4 cases. For all cases, we successfully performed transvenous coil embolization of the shunt. In 3 cases, we were able to perform balloon-assisted coil embolization of the shunt, which allowed the coils to be shorter and smaller, with an average length of 100 cm. The average number of coils was 10.4. In all cases, the shunt disappeared completely by angiography and the symptoms improved. There were no complications, such as hypoglossal nerve dysfunction after embolization. We demonstrated that balloon-assisted coil embolization for ACC DAVF was effective to prevent hypoglossal nerve palsy.