title: Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases.
abstract: BACKGROUND
  We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder.
  
  
  METHODS
  Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment.
  
  
  RESULTS
  Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a "magic wand" appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n = 2), transvenous embolization (TVE; n = 2), and TAE/TVE (n = 1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking.
  
  
  CONCLUSIONS
  The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction.
authors.affiliation: Department of Neurosurgery, University of Tokushima, Tokushima, Japan. smanabe-nsu@umin.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Manabe
authors.forename: Koichi
authors.initials: K
authors.lastname: Satoh
authors.forename: Shunji
authors.initials: S
authors.lastname: Matsubara
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.forename: Mami
authors.initials: M
authors.lastname: Hanaoka
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007601:Jugular Veins; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed