Acute subarachnoid hemorrhage in posterior condylar canal dural arteriovenous fistula: imaging features with endovascular management

• Published in: BMJ case reports Vol. 2014; p. bcr2014011273
• Main Authors: Mondel, Prabath Kumar, Saraf, Rashmi, Limaye, Uday S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 02-07-2014; BMJ Publishing Group
• Series: Case Report
• Subjects: Adult; Aneurysms; Central Nervous System Vascular Malformations - complications; Central Nervous System Vascular Malformations - diagnosis; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - therapy; Cerebral Angiography; Embolization, Therapeutic; Endovascular Procedures; Hemorrhage; Hemorrhagic Stroke; Humans; Male; Sinuses; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - etiology; Veins & arteries; CT Angiography; Balloon; Fistula; Liquid Embolic Material; Hemorrhage
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2014-011273

A 43-year-old man presented with acute subarachnoid hemorrhage. He was investigated and found to have a rare posterior condylar canal dural arteriovenous fistula (DAVF). DAVFs of the posterior condylar canal are rare. Venous drainage of the DAVF was through a long, tortuous, and aneurysmal bridging vein. We describe the clinical presentation, cross sectional imaging, angiographic features, and endovascular management of this patient. The patient was treated by transarterial embolization of the fistula through the ascending pharyngeal artery. This is the first report of an acutely bled posterior condylar canal DAVF treated by transarterial Onyx embolization with balloon protection in the vertebral artery. The patient recovered without any neurological deficit and had an excellent outcome. On 6 month follow-up angiogram, there was stable occlusion of the dural fistula.