Journal of neuroendovascular therapy · 2025
Strategic Detour in Transvenous Embolization via the Posterior Condylar Vein for Anterior Condylar Intraosseous Arteriovenous Fistula: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Yamashita Koki, Tanaka Yujiro, Yokoyama Tomoya, Kakizaki Yuta
Аннотация
OBJECTIVE: Anterior condylar (AC) arteriovenous fistulas (AVFs) can form intraosseous shunted pouches, and recent reports have suggested the involvement of the jugular tubercle venous complex (JTVC). Transvenous embolization (TVE) via the AC vein (ACV) is considered the 1st-line treatment. This paper reports a case of an intraosseous AC-AVF successfully treated with TVE via a strategic detour through the posterior condylar vein (PCV).
CASE PRESENTATION: A 60-year-old woman was suspected of having a dural AVF during the examination for pulsatile tinnitus. Detailed preoperative imaging studies using 3D rotational angiography (3D-RA) and cone-beam CT (CBCT) led to the diagnosis of an intraosseous AC-AVF. We were unable to navigate the catheter through a potentially existing direct pathway to the intraosseous shunted pouch, as it was not visualized on intraoperative angiography. Finally, we were able to navigate by tracing a unique drainage detour involving the PCV visualized on angiography and perform selective TVE. Postoperatively, the shunt completely disappeared, and the pulsatile tinnitus resolved.
CONCLUSION: Detailed preoperative imaging studies using 3D-RA and CBCT, as well as the use of a thin intermediate catheter, may have enabled the unique approach. In intraosseous shunts, guiding through the visualized drainage route, even when it involves a detour, may represent the most reasonable primary strategy.
CASE PRESENTATION: A 60-year-old woman was suspected of having a dural AVF during the examination for pulsatile tinnitus. Detailed preoperative imaging studies using 3D rotational angiography (3D-RA) and cone-beam CT (CBCT) led to the diagnosis of an intraosseous AC-AVF. We were unable to navigate the catheter through a potentially existing direct pathway to the intraosseous shunted pouch, as it was not visualized on intraoperative angiography. Finally, we were able to navigate by tracing a unique drainage detour involving the PCV visualized on angiography and perform selective TVE. Postoperatively, the shunt completely disappeared, and the pulsatile tinnitus resolved.
CONCLUSION: Detailed preoperative imaging studies using 3D-RA and CBCT, as well as the use of a thin intermediate catheter, may have enabled the unique approach. In intraosseous shunts, guiding through the visualized drainage route, even when it involves a detour, may represent the most reasonable primary strategy.