Accurate locating and intravenous embolization of hypoglossal canal dural arteriovenous fistula

Hypoglossal canal dural arteriovenous fistulas (HCDAVFs) are rare vascular anomalies involving pathological shunts near the hypoglossal canal. Their complex angioarchitecture and variable venous drainage (orbital, posterior fossa or spinal systems) lead to heterogeneous symptoms, such as pulsatile tinnitus and orbital congestion. Diagnosis relies on dynamic digital subtraction angiography (DSA), as noninvasive imaging lacks sensitivity. A single-center retrospective study analyzed 13 HCDAVF patients (2014–2024) with DSA-confirmed diagnosis. Treatment included transvenous embolization (TVE) using detachable coils and Onyx-18, with adjunctive techniques (balloon-assisted flow control). Outcomes were assessed via post-procedural DSA, clinical evaluations, and imaging follow-up. The cohort (10 males, mean age 59.2 years) presented with pulsatile tinnitus (61.5%), orbital congestion (69.2%), and headache (38.5%). TVE achieved complete occlusion in 84.6% (11/13), with immediate symptom resolution in 61.5% and durable occlusion in 69.2% at follow-up. Complications included transient nerve palsy (15.4%) and residual diplopia (15.4%). HCDAVFs require precise diagnosis via dynamic DSA and tailored endovascular strategies. TVE with coil-Onyx hybrid therapy achieved high technical success and durable outcomes. Future studies are needed to accumulate a larger case series and compare different interventional treatment strategies to improve cure rates, reduce recurrence rates and complications for HCDAVF.