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AJNR - American Journal of Neuroradiology

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Endovascular Treatment for Dural Arteriovenous Fistula of the Anterior Condylar Vein with Unusual Venous Drainage: Report of Two Cases

Shuichi Tanoue^a, Katsuya Goto^a and Shinzo Oota^a

^a From the Department of Endovascular Neurosurgery, Oota Memorial Hospital, Fukuyama, Japan

View larger version (126K): [in a new window]   FIG 1. Preoperative T2-weighted MR image. The medulla oblongata and cervical spinal cord show diffuse high signal intensity. Note the tortuous signal intensity voids in the premedullary subarachnoid space (arrows).

View larger version (112K): [in a new window]   FIG 2. Frontal (A) and lateral (B) views of preoperative external carotid arteriography. The dural arteriovenous fistula is fed by neuromeningeal branches of the ascending pharyngeal artery (white arrow) and a jugular branch of the occipital artery (black arrow) and drains into the pontomesencephalic vein (arrowheads).

View larger version (176K): [in a new window]   FIG 3. Source image of contrast-enhanced 3D MR angiography. The branches of the ascending pharyngeal artery (white arrow) flow into the anterior condylar vein (black arrow). The arrowhead indicates the dilated anterior pontomesencephalic vein draining from the anterior condylar vein.

View larger version (88K): [in a new window]   FIG 4. Schematic drawing of the dural arteriovenous fistula and surrounding venous structures in case 1. APA indicates the ascending pharyngeal artery; DV, drainage vein; CS, cavernous sinus; SPS, superior petrosal sinus; IPS, inferior petrosal sinus; BP, basilar plexus; MS, marginal sinus; JV, jugular vein.

View larger version (141K): [in a new window]   FIG 5. MR image obtained at 14 months after the procedure. The brain stem and spinal cord edema has completely disappeared. Low-signal-intensity areas (arrows) indicate deposition of hemosiderin due to previous venous congestion and infarction.

View larger version (178K): [in a new window]   FIG 6. Preoperative T2-weighted MR image. A saccular signal intensity void is seen in the left hypoglossal canal (arrow).

View larger version (110K): [in a new window]   FIG 7. Frontal (A) and lateral (B) views of preoperative external carotid arteriography. The dural arteriovenous fistula is fed by meningeal branches of the ascending pharyngeal artery and occipital artery. A dilated venous sac is seen at the fistulous point (arrow). Note the retrograde venous drainage via the inferior petrosal sinus and cavernous sinus (arrowheads).

View larger version (167K): [in a new window]   FIG 8. Source image of time-of-flight MR angiography. The saccular high signal intensity indicates the venous sac of the anterior condylar dural arteriovenous fistula (arrow).

View larger version (95K): [in a new window]   FIG 9. Frontal (A) and lateral (B) views of a postoperative angiogram. The dural arteriovenous fistula has completely disappeared. The arrows indicate the mass of metallic coils placed in the venous pouch.