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AJNR - American Journal of Neuroradiology

Published ahead of print on February 26, 2009
doi: 10.3174/ajnr.A1528

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Intraosseous Cranial Dural Arteriovenous Fistula Treated with Transvenous Embolization

C. Jung^a,d, B.J. Kwon^a,f, O.-K. Kwon^b,e, S.K. Baikⁱ, M.H. Han^a,b,c,f,h, J.E. Kim^b,g and C.W. Oh^b,e

^a Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
^b Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
^c Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
^d Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
^e Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
^f Department of Radiology, Seoul National University Hospital, Seoul, Korea
^g Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
^h Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
ⁱ Department of Radiology, Pusan National University Yangsan Hospital, Busan, Korea

View larger version (141K): [in this window] [in a new window]   Fig 1. Case 3. Axial noncontrast CT scans with a bone window setting (A) and a T2-weighted axial MR image (B) show the osteolytic lesion and signal-intensity void, respectively (white arrow), which correspond to the intraosseous venous pouch (asterisks in D and E) and are located at the lower clivus around the hypoglossal canal (double arrow in D). Selective angiography of the right ascending pharyngeal artery (C) and coronal reconstructed images of rotational angiography (D–G) show a fistula between the artery and dilated venous pouch (arrowhead in E) and venous drainage into vertebral venous system, such as the venous plexus, around the horizontal segment of the vertebral artery (dotted arrow) via the posterior condylar vein (open arrow in C and F). After transvenous embolization, coil was packed within the dilated venous pouch (H).

View larger version (118K): [in this window] [in a new window]   Fig 2. Case 6. The intraosseous venous pouch (arrows in A and B) was located at the left lower clivus around the hypoglossal canal, and selective angiography of the ascending pharyngeal artery confirmed an arteriovenous shunt (C), which was more correctly localized by the contralateral common carotid angiography (D). The venous connection (open arrowhead) between the intraosseous venous pouch and the internal jugular vein (double arrows) was so obvious on the coronal reconstructed image of rotational angiography (E) that the intraosseous venous pouch and venous connection could be completely occluded by the transvenous embolization (F).