Article Figures & Data
Figures
- FIG 1.
DSA images via left external carotid artery injection from a patient with a left petrous AVF (patient 5) demonstrate the anatomy of the facial nerve arterial arcade. A, Anterior-posterior projection demonstrates supply to the fistula by the petrous branch of the left MMA (white arrow), stylomastoid branch of the left posterior auricular artery (black arrows), and the anastomotic arcade between these 2 arteries (black-border arrow). B, Lateral projection shows the petrous branch of the MMA (white arrow), stylomastoid artery (black arrow), and the anastomotic facial nerve arterial arcade (black-border arrow). C, Anterior-posterior projection during selective injection of the left posterior auricular artery confirms supply to the fistula from the left stylomastoid artery (black arrow). D, Lateral projection during selective left ascending pharyngeal artery injection demonstrates additional supply to the AVF from its hypoglossal branch (white arrow).
- FIG 2.
Retrospective summary of our treatment strategy algorithm for petrous dural AVFs.
- FIG 3.
DSA and transarterial embolization using EVOH copolymer of a right-sided Borden III/Cognard IV petrous dural AVF. All images are in the lateral projection. A, Right external carotid artery injection demonstrates arterial supply to the AVF from the squamous temporal branch of the right MMA (black-border arrow) from an enlarged petrous branch of the MMA (white arrow) and from an enlarged stylomastoid artery (black arrow). Note that the facial nerve arterial arcade is formed by the latter 2 vessels. B, A microcatheter is present in the squamous branch of the MMA (black-border arrow). Microcatheter injection DSA from a distal point in the vessel demonstrates the fistulous point (white arrow) entering an ectatic petrosal varix. C, Spot film following EVOH embolization via the squamous branch of the MMA demonstrates the EVOH cast (black arrow) across the fistulous point and into the venous sac. The proximal marker of the detachable tip is visible (white arrow). D, Magnified right common carotid artery injection following embolization demonstrates the subtracted EVOH cast (black-border arrow) with no remnant filling of the AVF. The petrous branch of the MMA (white arrows) and the stylomastoid artery (black arrow) remain patent after treatment. The patient had preserved facial nerve function postprocedure.
