Endovascular Treatment and Computed Imaging Follow-up of 14 Anterior Condylar Dural Arteriovenous Fistulas

We report our experience in treating the anterior condylar dural arteriovenous fistula (DAVF) and confirm the location of the coils in the follow-up images after successful endovascular treatment.

We retrospectively reviewed the 14 patients with anterior condylar DAVF treated successfully in our institute. Twelve of them had CT or MR follow-up images. All the patients had intravascular coiling of the fistula. Seven of our patients had retrograde drainage to different sinuses. Three had ocular symptoms as a clinical manifestation. We treated nine patients with coils alone (eight transvenous, one transarterial), four with adjuvant transarterial treatment with particles or liquid embolic for minimal residual after coiling packing. One patient had failed onyx treatment and successful treatment by following transvenous packing. All patients had total obliteration of the DAVF fistula on immediate post-procedure angiogram or on the follow-up images and no evidence of recurrence clinically. The mean follow-up period was 34.2 months (standard deviation=39.8). Twelve patients had computed images (CT alone in four, MR alone in five, both CT and MR in three). These findings were analyzed by four certified neuroradiologists. We found 100% of the coils at the anterior condylar veins inside the hypoglossal canal, 54.2% at the lateral lower clivus, and only 14.2% at the anterior condylar confluence which is ventrolateral to the anterior orifice of the hypoglossal canal.

Intravascular coiling is the treatment of choice in patients with anterior condylar DAVF. All the coils were found at the anterior condylar veins inside the hypoglossal canal after successful treatment.