Multiple Dural Arteriovenous Fistulas Manifesting as Progressive Otalgia and Tinnitus and Treated Using a Single Session of Endovascular Embolization

Background: Multiple cranial dural arteriovenous fistulas (dAVFs) are considered to be an uncommon vascular condition. dAVFs usually manifest with vague symptoms, which are related to the site of occurrence of the lesion and present with complex angio-architectural features, which in turn can render treatment procedures difficult. Appropriate treatment that aims to reduce the risk of intracranial bleeding and manage the patient's symptoms requires a multidisciplinary approach.

Case presentation: The patient was a 62-year-old man who developed symptoms of progressive right-sided otalgia and tinnitus. Cross-sectional imaging revealed long-standing venous congestion with intracranial hemorrhage in the right parieto-occipital region. Moreover, cerebral angiography demonstrated multiple complex dAVFs at the right transverse sinus-sigmoid sinus (TS-SS) junction, right posterior condylar confluence (PCC), and torcula. Treatment consisted of one session of endovascular treatment, in which transarterial Onyx embolization was used to treat the dVAF at the right TS-SS junction, transvenous coil embolization for the dVAF at the right PCC, and particle embolization for both occipital arteries feeding the torcular dAVF. Postoperative improvement with favorable clinical outcomes was observed at the patient's last follow-up visit.

Conclusion: Multiple cranial dAVFs are an uncommon vascular lesion, which can present with unusual symptoms such as otalgia. Moreover, a single session of endovascular therapy can treat this lesion, ie, it can improve the patient's symptoms and provide a beneficial long-term outcome.