Dural arteriovenous fistula mimicking CCF

• 51-year-old female patient
• RTA on 22/09/2022 with right frontal contusion and fracture of the right temporal bone
• Slight redness of the right eye for 6 weeks
• Pulsatile tinnitus on the right side and auricular fullness
• Elevated right intraocular pressure
• Digital subtraction angiography (DSA) showed a dural arteriovenous fistula (DAVF) of the right occipital condyle with feeding arteries mainly from the jugular branch of the neuromeningeal division of the ascending pharyngeal artery

CT findings

Dilated right SOV  /  Cavernous bulging

Bone window CT and CTA

 
Intraosseous vascular lesion on the bone window and corresponding area in CTA

Diagnostic approach

• Under GA
• 5F vascular sheath right femoral artery
• For Diagnostics - 5F vertebral catheter with 0.035” wire

Digital subtraction angiography (DSA)

Digital subtraction angiography (DSA) showed a dural arteriovenous fistula (DAVF) of the right occipital condyle with feeding arteries originating mainly from the neuromeningeal division of the ascending pharyngeal artery.

3D RA

• 5F right femoral vein sheath
• 5F soft-tip with Headway 21 microcatheter (Microvention) & Runthrough microwire (Terumo) in coaxial fashion.
• Superselection to the venous pouch.
• Coils - eV3 Concerto fiber detachable coils
  – Helix 12 mm x 30 cm- distal IPS
  – Helix 8 mm x 30 cm, 7 mm x 30 cm, 5 mm x 20 cm- venous pouch

Pre- and post- treatment angiogram - lateral view 

Superselection - lateral view /  post-coil embolization - lateral view  /  Complete obliteration of fistula - lateral view

Pre- and post- treatment angiogram - AP view

Superselection - AP view  /   Post-coil embolization - AP view  /  Complete obliteration of fistula - AP view

Pre- and Post- treatment - coil mass position

• Arteriovenous shunts mimicking CCF are rare and can be confusing.
• The clinical presentation mainly depends on the venous outflow.
• Occlusion of the most proximal venous pouch is an effective treatment.
• Transvenous coil embolization is curative and effective when venous excess is available.