scholarly journals Isolated Hypoglossal Nerve Palsy Due to Endovascular Treatment of a Dural Arteriovenous Fistula with Onyx-18

2010 ◽  
Vol 16 (3) ◽  
pp. 286-289 ◽  
Author(s):  
W. Pei ◽  
S. Huai-Zhang ◽  
X. Shan-Cai ◽  
G. Cheng ◽  
Z. Di
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Nerve Palsy ◽  
Dural Arteriovenous Fistula ◽  
Hypoglossal Nerve ◽  
Transvenous Embolization ◽  
Prednisolone Therapy ◽  
Hypoglossal Nerve Palsy ◽  
Hypoglossal Canal ◽  
First Case

We describe a patient with dural arteriovenous fistula (DAVF) treated with Onyx-18 who developed isolated hypoglossal nerve palsy. This is the first case of isolated hypoglossal nerve palsy caused by Onyx-18 embolization. This complication suggests that over embolization with Onyx-18 in the treatment of hypoglossal canal DAVFs should be avoided, and transvenous embolization may be safer. Furthermore, prednisolone therapy should be carried out in the prophase of nerve palsy.

scholarly journals Intraoperative cone-beam computed tomography contributes to avoiding hypoglossal nerve palsy during transvenous embolization for dural arteriovenous fistula of the anterior condylar confluence

2016 ◽  
Vol 22 (5) ◽  
pp. 584-589 ◽  
Author(s):  
Akitake Okamura ◽  
Mitsuo Nakaoka ◽  
Naohiko Ohbayashi ◽  
Kaita Yahara ◽  
Shinya Nabika
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Nerve Palsy ◽  
Dural Arteriovenous Fistula ◽  
Hypoglossal Nerve ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Transvenous Embolization ◽  
Hypoglossal Nerve Palsy ◽  
Hypoglossal Canal

Background Dural arteriovenous fistula of the anterior condylar confluence (ACC-DAVF) is a rare subtype of DAVFs that occurs around the hypoglossal canal. Transvenous embolization (TVE) with coils has been performed for most ACC-DAVFs with a high clinical cure rate. However, some reports call attention to hypoglossal nerve palsy associated with TVE due to coil mass compression of the hypoglossal nerve caused by coil deviation from the ACC to the anterior condylar vein (ACV). Herein, we report a case of ACC-DAVF in which an intraoperative cone-beam computed tomography (CT) contributed to avoiding hypoglossal nerve palsy. Case presentation A 74-year-old man presented with left pulse-synchronous tinnitus. An angiography detected left ACC-DAVF mainly supplied by the left ascending pharyngeal artery and mainly drained through the ACV. The two fistulous points were medial side of the ACC and the venous pouch just cranial of the ACC. We performed TVE detecting the fistulous points by contralateral external carotid angiography (ECAG). The diseased venous pouch and ACC were packed with seven coils but a slight remnant of the DAVF was recognized. Because a cone-beam CT revealed that the coil mass was localized in the lateral lower clivus osseous without deviation to the hypoglossal canal, we finished TVE to avoid hypoglossal nerve palsy. Postoperatively, no complication was observed. No recurrence of symptoms or imaging findings were detected during a five-month follow-up period. Conclusion An intraoperative cone-beam CT contributed to avoiding hypoglossal nerve palsy by estimating the relationship between the coil mass and the hypoglossal canal during TVE of ACC-DAVF.

scholarly journals Dural Arteriovenous Fistula at the Anterior Condylar Confluence

2008 ◽  
Vol 14 (3) ◽  
pp. 303-312 ◽  
Author(s):  
S. Miyachi ◽  
T. Ohshima ◽  
T. Izumi ◽  
T. Kojima ◽  
J Yoshida
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Three Dimensional ◽  
Drainage Pattern ◽  
Hypoglossal Canal ◽  
Shunt Occlusion ◽  
Meningeal Arteries ◽  
Anterior Condylar Vein ◽  
Angiographic Findings

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence. Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern. Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy. Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.

scholarly journals Cavernous sinus dural arteriovenous fistula accessed through a straightened superficial temporal vein

2021 ◽  
Vol 12 ◽  
pp. 634
Author(s):  
Teishiki Shibata ◽  
Yusuke Nishikawa ◽  
Takumi Kitamura ◽  
Mitsuhito Mase
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Chronic Total Occlusion ◽  
Nerve Palsy ◽  
Dural Arteriovenous Fistula ◽  
Abducens Nerve ◽  
Transvenous Embolization ◽  
Access Route ◽  
Treatment Procedure ◽  
Total Occlusion

Background: Transvenous embolization through the inferior petrosal sinus (IPS) is the most common treatment procedure for cavernous sinus dural arteriovenous fistula (CSDAVF). When the IPS is inaccessible or the CSDAVF cannot be treated with transvenous embolization through the IPS, the superficial temporal vein (STV) is used as an alternative access route. However, the approach through the STV is often challenging because of its tortuous and abruptly angulated course. We report a case of recurrent CSDAVF which was successfully treated using a chronic total occlusion (CTO)-dedicated guidewire and by straightening the STV. Case Description: A 63-year-old woman was diagnosed with CSDAVF on examination for oculomotor and abducens nerve palsy. She was initially treated with transvenous embolization through the IPS. However, CSDAVF recurred, and transvenous embolization was performed through the STV. A microcatheter could not be navigated because of the highly meandering access route through the STV. By inserting a CTO-dedicated guidewire into the microcatheter, the STV was straightened and the microcatheter could be navigated into a shunted pouch of the CS. Finally, complete occlusion of the CSDAVF was achieved. Conclusion: If an access route is highly meandering, the approach can be facilitated by straightening the access route with a CTO-dedicated guidewire.

Hypoglossal canal dural arteriovenous fistula: incidence and the relationship between symptoms and drainage pattern

2013 ◽  
Vol 119 (4) ◽  
pp. 955-960 ◽  
Author(s):  
Jong Won Choi ◽  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Dong Ik Kim ◽  
Sang Hyun Suh ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Treatment Outcomes ◽  
Coil Embolization ◽  
Dural Arteriovenous Fistula ◽  
Drainage Pattern ◽  
Radiographic Findings ◽  
Hypoglossal Canal ◽  
Presenting Symptoms ◽  
Ocular Symptoms

Object The purpose of this study was to evaluate the incidence, radiographic findings, relationship between presenting symptoms for treatment and drainage pattern, and treatment outcomes of hypoglossal canal dural arteriovenous fistula (HC-dAVF). Methods During a 16-year period, 238 patients underwent endovascular treatment for cranial dAVF at a single center. The incidence, radiographic findings, relationship between presenting symptoms for treatment and drainage pattern, and treatment outcomes of HC-dAVF were retrospectively evaluated. Results The incidence of HC-dAVF was 4.2% (n = 10). Initial symptoms were tinnitus with headache (n = 6), tinnitus only (n = 1), ocular symptoms (n = 1), otalgia (n = 1), and congestive myelopathy (n = 1). Presenting symptoms requiring treatment included ocular symptoms (n = 4), hypoglossal nerve palsy (n = 4), aggravation of myelopathy (n = 1), and aggravation of tinnitus with headache (n = 1). While the affected HC was widened in 4 of 10 patients, hypersignal intensity on source images was conspicuous in all 7 patients who underwent MR angiography (MRA). All ocular symptoms and congestive myelopathy were associated with predominant drainage to superior ophthalmic or perimedullary veins due to antegrade drainage restriction. All patients who underwent transvenous coil embolization (n = 8) or transarterial N-butyl cyanoacrylate (NBCA) embolization (n = 1) improved without recurrence. One patient who underwent transarterial particle embolization had a recurrence 12 months posttreatment and was retreated with transvenous embolization. Conclusions The incidence of HC-dAVF was 4.2% of all cranial dAVF patients who underwent endovascular treatment. Source images of MRA helped to accurately diagnose HC-dAVF. More aggressive symptoms may develop as a result of a change in the predominant drainage route due to the development of venous stenosis or obstruction over time. Transvenous coil embolization appears to be the first treatment of choice.

Successful conservative treatment of an intracranial pneumatocele with post-traumatic hypoglossal nerve palsy secondary to diffuse temporal bone pneumocele: case report and review of the literature

2017 ◽  
Vol 131 (2) ◽  
pp. 181-184 ◽  
Author(s):  
M A Taube ◽  
G M Potter ◽  
S K Lloyd ◽  
S R Freeman
Keyword(s):  
Case Report ◽  
Temporal Bone ◽  
Nerve Palsy ◽  
Soft Tissues ◽  
Hypoglossal Nerve ◽  
Management Options ◽  
Tension Pneumocephalus ◽  
Hypoglossal Nerve Palsy ◽  
Hypoglossal Canal ◽  
Slow Expansion

AbstractBackground:A pneumocele occurs when an aerated cranial cavity pathologically expands; a pneumatocele occurs when air extends from an aerated cavity into adjacent soft tissues forming a secondary cavity. Both pathologies are extremely rare with relation to the mastoid. This paper describes a case of a mastoid pneumocele that caused hypoglossal nerve palsy and an intracranial pneumatocele.Case report:A 46-year-old man presented, following minor head trauma, with hypoglossal nerve palsy secondary to a fracture through the hypoglossal canal. The fracture occurred as a result of a diffuse temporal bone pneumocele involving bone on both sides of the hypoglossal canal. Further slow expansion of the mastoid pneumocele led to a secondary middle fossa pneumatocele. The patient refused treatment and so has been managed conservatively for more than five years, and he remains well.Conclusion:While most patients with otogenic pneumatoceles have presented acutely in extremis secondary to tension pneumocephalus, our patient has remained largely asymptomatic. Aetiology, clinical features and management options of temporal bone pneumoceles and otogenic pneumatoceles are reviewed.

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