Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach

Hypoglossal canal dural arteriovenous fistulas (HC-DAVF) involve the anterior condylar vein (ACV) and anterior condylar confluence (ACC). They often present with tinnitus, bruit, and hypoglossal nerve palsy. The most common treatment in HC-DAVFs is transvenous embolization using coils and the most direct transvenous route is the trans-internal jugular vein access. When this approach is not feasible, a treatment attempt is possible through alternative routes. We report 2 patients with DAVFs involving the anterior condylar confluence. The first patient presented with pulsatile tinnitus and hypoglossal nerve palsy, and was treated by a standard transjugular approach. The second patient presented with pulse-synchronous bruit. Following an unsuccessful attempt of the transjugular approach, the fistulous point was reached via the deep cervical vein and complete occlusion was achieved by coil deployment. Both patients had complete regression of symptoms. Endovascular therapy is the elective treatment for HC-DAVFs and the transjugular approach is the most commonly used. The deep cervical vein (DCV) can be an alternative transvenous route when the transjugular approach fails.

Download Full-text

Dural arteriovenous fistula of the anterior condylar confluence and hypoglossal canal mimicking a jugular foramen tumor

Journal of Neurosurgery ◽

10.3171/jns/2008/109/8/0335 ◽

2008 ◽

Vol 109 (2) ◽

pp. 335-340 ◽

Cited By ~ 15

Author(s):

James K. Liu ◽

Kelly Mahaney ◽

Stanley L. Barnwell ◽

Sean O. McMenomey ◽

Johnny B. Delashaw

Keyword(s):

Nerve Palsy ◽

Hypoglossal Nerve ◽

Transarterial Embolization ◽

Jugular Foramen ◽

Jugular Bulb ◽

Venous Plexus ◽

Hypoglossal Nerve Palsy ◽

Hypoglossal Canal ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

The anterior condylar confluence (ACC) is located on the external orifice of the canal of the hypoglossal nerve and provides multiple connections with the dural venous sinuses of the posterior fossa, internal jugular vein, and the vertebral venous plexus. Dural arteriovenous fistulas (DAVFs) of the ACC and hypoglossal canal (anterior condylar vein) are extremely rare. The authors present a case involving an ACC DAVF and hypoglossal canal that mimicked a hypervascular jugular bulb tumor. This 53-year-old man presented with right hypoglossal nerve palsy. A right pulsatile tinnitus had resolved several months previously. Magnetic resonance imaging demonstrated an enhancing right-sided jugular foramen lesion involving the hypoglossal canal. Cerebral angiography revealed a hypervascular lesion at the jugular bulb, with early venous drainage into the extracranial vertebral venous plexus. This was thought to represent either a glomus jugulare tumor or a DAVF. The patient underwent preoperative transarterial embolization followed by surgical exploration via a far-lateral transcondylar approach. At surgery, a DAVF was identified draining into the ACC and hypoglossal canal. The fistula was surgically obliterated, and this was confirmed on postoperative angiography. The patient's hypoglossal nerve palsy resolved. Dural arteriovenous fistulas of the ACC and hypoglossal canal are rare lesions that can present with isolated hypoglossal nerve palsies. They should be included in the differential diagnosis of hypervascular jugular bulb lesions. The authors review the anatomy of the ACC and discuss the literature on DAVFs involving the hypoglossal canal.

Download Full-text

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

Interventional Neuroradiology ◽

10.1177/159101991001600310 ◽

2010 ◽

Vol 16 (3) ◽

pp. 286-289 ◽

Cited By ~ 13

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.

Download Full-text

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215116009816 ◽

2017 ◽

Vol 131 (2) ◽

pp. 181-184 ◽

Cited By ~ 3

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.

Download Full-text

Isolated Hypoglossal Nerve Palsy Due to Metastatic Germinoma in the Neck: A Ventriculoatrial Shunt-related Complication

Neurosurgery ◽

10.1227/00006123-198808000-00021 ◽

1988 ◽

Vol 23 (2) ◽

pp. 237-240 ◽

Cited By ~ 7

Author(s):

Edmund Woo ◽

Yuk-Ling Yu

Keyword(s):

Nerve Palsy ◽

Hypoglossal Nerve ◽

Jugular Vein ◽

Vascular Tumor ◽

Neck Mass ◽

Ventriculoatrial Shunt ◽

Related Complication ◽

Hypoglossal Nerve Palsy ◽

Suprasellar Germinoma ◽

The Right

ABSTRACT A 12-year-old boy with suprasellar germinoma was treated with a right-sided ventriculoatrial shunt at diagnosis. He subsequently developed a metastatic neck mass that presented with an isolated right hypoglossal nerve palsy. Radiological investigations showed a vascular tumor and thrombosis of the right internal jugular vein. It is hypothesized that thrombosis at the venous inflow channel allowed local proliferation of the tumor cells that exited from the intracranial cavity via the shunt.

Download Full-text

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

Interventional Neuroradiology ◽

10.1177/1591019916654141 ◽

2016 ◽

Vol 22 (5) ◽

pp. 584-589 ◽

Cited By ~ 8

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.

Download Full-text