Endovascular Coil Embolization for Dural Arteriovenous Fistula of Anterior Condylar Confluence: A Case Report

We report a case of endovascular coil embolization for dural arteriovenous fistula (DAVF) of anterior condylar confluence (ACC). A 43-year-old man with hyperlipidemia was admitted with the left pulsatile tinnitus. Angiograms revealed DAVF at the ACC. The arterial supply was the left ascending pharyngeal artery, and the main drainage was vertebral venous plexus. The transvenous coil embolization was performed. The shunt flow decreased gradually, but not disappeared completely. During the procedure, we changed treatment strategy from venous side to the transarterial embolization. The shunt flow was disappeared except draining into vertebral venous plexus, and the patient'fs symptoms improved. ACC is venous confluence of 3-5 mm near the jugular bulb. ACC DAVF is extremely rare. In late years, ACC attracts its attention as craniocervical venous system is understood. ACC DAVF has been assumed to be marginal sinus DAVF or hypoglossal canal DAVF. Surrounding anatomy of ACC venous connection, arterial supply, drainer, and cranial nerve is important to make a treatment strateffv