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

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.

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

Interventional Neuroradiology ◽

10.1177/1591019920961199 ◽

2020 ◽

pp. 159101992096119

Author(s):

Rasmus Holmboe Dahl ◽

Alessandra Biondi ◽

Fortunato Di Caterino ◽

Giovanni Vitale ◽

Lars Poulsgaard ◽

...

Keyword(s):

Nerve Palsy ◽

Hypoglossal Nerve ◽

Jugular Vein ◽

Complete Regression ◽

Unsuccessful Attempt ◽

Hypoglossal Nerve Palsy ◽

Hypoglossal Canal ◽

Arteriovenous Fistulas ◽

Vein Access ◽

Alternative Routes

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.

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Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

Interventional Neuroradiology ◽

10.1177/15910199970030s217 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 88-92

Author(s):

N. Kuwayama ◽

S. Endo ◽

M. Kubo ◽

T. Akai ◽

A. Takaku

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Transarterial Embolization ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Arteriovenous Fistulas ◽

Type D ◽

Dural Arteriovenous Fistulas ◽

The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

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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.

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Dural arteriovenous fistulas of the hypoglossal canal: systematic review on imaging anatomy, clinical findings, and endovascular management

Journal of Neurosurgery ◽

10.3171/2014.10.jns14377 ◽

2015 ◽

Vol 122 (4) ◽

pp. 883-903 ◽

Cited By ~ 35

Author(s):

Björn Spittau ◽

Diego San Millán ◽

Saad El-Sherifi ◽

Claudia Hader ◽

Tejinder Pal Singh ◽

...

Keyword(s):

Cavernous Sinus ◽

Case Reports ◽

Transarterial Embolization ◽

Venous Anatomy ◽

Hypoglossal Canal ◽

Arteriovenous Fistulas ◽

Small Series ◽

Dural Arteriovenous Fistulas ◽

Type 3

Dural arteriovenous fistulas (DAVFs) of the hypoglossal canal (HCDAVFs) are rare and display a complex angiographic anatomy. Hitherto, they have been referred to as various entities (for example, “marginal sinus DAVFs”) solely described in case reports or small series. In this in-depth review of HCDAVF, the authors describe clinical and imaging findings, as well as treatment strategies and subsequent outcomes, based on a systematic literature review supplemented by their own cases (120 cases total). Further, the involved craniocervical venous anatomy with variable venous anastomoses is summarized. Hypoglossal canal DAVFs consist of a fistulous pouch involving the anterior condylar confluence and/or anterior condylar vein with a variable intraosseous component. Three major types of venous drainage are associated with distinct clinical patterns: Type 1, with anterograde drainage (62.5%), mostly presents with pulsatile tinnitus; Type 2, with retrograde drainage to the cavernous sinus and/or orbital veins (23.3%), is associated with ocular symptoms and may mimic cavernous sinus DAVF; and Type 3, with cortical and/or perimedullary drainage (14.2%), presents with either hemorrhage or cervical myelopathy. For Types 1 and 2 HCDAVF, transvenous embolization demonstrates high safety and efficacy (2.9% morbidity, 92.7% total occlusion). Understanding the complex venous anatomy is crucial for planning alternative approaches if standard transjugular access is impossible. Transarterial embolization or surgical disconnection (morbidity 13.3%–16.7%) should be reserved for Type 3 HCDAVFs or lesions with poor venous access. A conservative strategy could be appropriate in Type 1 HCDAVF for which spontaneous regression (5.8%) may be observed.

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Selective Transvenous Embolization of Dural Arteriovenous Fistulas Involving the Hypoglossal Canal

Interventional Neuroradiology ◽

10.1177/159101990701300108 ◽

2007 ◽

Vol 13 (1) ◽

pp. 59-66 ◽

Cited By ~ 22

Author(s):

M. Okahara ◽

H. Kiyosue ◽

S. Tanoue ◽

Y. Sagara ◽

Y. Hori ◽

...

Keyword(s):

Jugular Vein ◽

Critical Evaluation ◽

Venous Drainage ◽

Transvenous Embolization ◽

Venous Plexus ◽

Venous Anatomy ◽

Hypoglossal Canal ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Posterior Condylar

The hypoglossal canal contains a venous plexus that connects the inferior petrous sinus, condylar vein, jugular vein and paravertebral plexus. The venous plexus is one of the venous drainage routes of the posterior skull base. Only a few cases of dural arteriovenous fistulas (AVFs) involving the hypoglossal canal have been reported. We describe three cases (a 62-year-old female, a 52-year-old male, and an 83-year-old male) of dural AVFs involving the hypoglossal canal. Symptoms were pulse-synchronous bruit in two cases and proptosis/chemosis in one. All dural AVFs were mainly fed by the ipsilateral ascending pharyngeal artery. Two of three dural AVFs involving the hypoglossal canal mainly drained through the anterior condylar confluence into the inferior petrosal sinus retrogradely with antegrade drainage through the lateral condylar vein. The other one drained through the lateral and posterior condylar veins into the suboccipital cavernous sinus. All dural AVFs were completely occluded by selective transvenous embolization without any complications, and the symptoms disappeared within one week in all cases. Dural AVFs involving the hypoglossal canal can be successfully treated by selective transvenous embolization with critical evaluation of venous anatomy in each case.

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A jugular foramen schwannoma with hypoglossal nerve palsy as a first symptom: A case report

Japanese Journal of Oral & Maxillofacial Surgery ◽

10.5794/jjoms.67.384 ◽

2021 ◽

Vol 67 (6) ◽

pp. 384-390

Author(s):

Takafumi NAKANO ◽

Miwako SASE ◽

Masato TAKAHASHI ◽

Hitoshi OSANO ◽

Yoshiyuki MORI ◽

...

Keyword(s):

Case Report ◽

Nerve Palsy ◽

Hypoglossal Nerve ◽

Jugular Foramen ◽

Hypoglossal Nerve Palsy

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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.

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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.

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