December 2020
A 71 year old male presented with 1-year history of ocular symptoms (diplopia, proptosis, episcleral congestion).
Case contributed by –
Department of Imaging Sciences and Intervention Radiology, SCTIMST, Trivandrum (from ISNR 2020 online quiz)
Tangle of vessels in the TOF MRA at the hypoglossal canal. ASL demonstrating arterialized signal in right cavernous sinus, TOF MRA shows early filling of right cavernous sinus, DSA demonstrating feeders, fistula location and venous drainage.
Final diagnosis – hypoglossal (anterior condylar confluence-acc) dural AV fistula with retrograde (cavernous sinus) drainage.
- Rare posterior fossa dural AV fistula.
- Fistula is seen between ECA (ascending pharyngeal arteries) and anterior condylar vein in the hypoglossal canal
- It retrogradely drains into cavernous sinus through inferior petrosal sinus and manifests like CCF
- ASL can be useful to identify the fistula by demonstrating arterial signal in the veins (cavernous in our case).
- Treatment: Surgery or embolization.
Great learning case. Compliments on diagnosing the case. Pl share how the case has been managed.