Targeted transvenous embolization of a dural arteriovenous fistula at the jugular tubercle venous complex

Abstract

Background: Dural arteriovenous fistulas (dAVFs) occurring near the hypoglossal canal are rare. Detailed evaluation of vascular structures can identify shunt pouches at the jugular tubercle venous complex (JTVC) in the bone near the hypoglossal canal. Although the JTVC has several venous connections, including the hypoglossal canal, there have been no reports of transvenous embolization (TVE) of a dAVF at the JTVC using an approach route other than the hypoglossal canal. This report describes the first case of complete occlusion with targeted TVE using an alternative approach route in a 70-year-old woman presenting with tinnitus diagnosed with dAVF at the JTVC. Case Description: The patient had no history of head trauma or other preexisting conditions. Magnetic resonance imaging (MRI) showed no abnormal findings in the brain parenchyma. Magnetic resonance angiography (MRA) revealed a dAVF near the ACC. The shunt pouch was located in the JTVC, near the left hypoglossal canal, with feeders from the bilateral ascending pharyngeal arteries and occipital arteries, left meningohypophyseal trunk, and odontoid arch of the left vertebral artery. TVE was performed near the shunt pouch. Localized packing of the shunt point was achieved. The patient’s tinnitus improved. Postoperative MRI showed disappearance of the shunt without any complications. No recurrence was observed on MRA 6 months after treatment. Conclusion: Our results suggest targeted TVE is an effective treatment for dAVFs at the JTVC.