Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications.
Pulsatile tinnitus (PT) is often an initial presenting symptom of dural arteriovenous fistula (dAVF), but it may be overlooked or diagnosed late if not suspected on initial diagnostic work-up. Here, we assess anatomical features, treatment outcomes, and clinical implications of patients with PT due to dAVF. Of 220 patients who were diagnosed with dAVF between 2003 and 2014, 30 (13.6%) presented with only PT as their initial symptom. The transverse-sigmoid sinus (70.0%) was the most common site, followed by the hypoglossal canal (10.0%) and the middle cranial fossa (6.7%) on radiologic evaluation. Regarding venous drainage patterns, sinus or meningeal venous drainage pattern was the most common type (73.3%), followed by sinus drainage with a cortical venous reflux (26.7%). PT disappeared completely in 21 (80.8%) of 26 patients who underwent therapeutic intervention with transarterial embolization of the fistula, improved markedly in 3 (11.5%), and remained the same in 2 (7.7%). In conclusion, considering that PT may be the only initial symptom in more than 10% of dAVF, not only otolaryngologists but also neurologists and neurosurgeons should meticulously evaluate patients with PT. In most cases, PT originating from dAVF can be cured with transarterial embolization regardless of location and venous drainage pattern.
Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University, Eulji Medical Center, Seoul, Korea.
Yong-Hwi
YH
An
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Sungjun
S
Han
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Minhyung
M
Lee
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Jihye
J
Rhee
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
O-Ki
OK
Kwon
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Gyojun
G
Hwang
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Cheolkyu
C
Jung
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Yun Jung
YJ
Bae
Music and Audio Research Group, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
Gwang Seok
GS
An
Music and Audio Research Group, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
Kyogu
K
Lee
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Ja-Won
JW
Koo
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Jae-Jin
JJ
Song
D000328:Adult; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014012:Tinnitus / Q000000981:diagnostic imaging* / Q000473:pathology; D016896:Treatment Outcome