Posterior cranial fossa dural arteriovenous fistula - pulsatile tinnitus
Presentation
Assymetrical hearing loss and pulsatile tinnitus for some months.
Patient Data
Large vascular lesion in left posterior fossa passing through the diploe of the left occipital bone (ROI) to enter the left transverse sinus. Note arterialized blood in the sinus (high signal on the MRA segmentations) and enlarged feeding arteries ie middle meningeal at foramen spinosum (arrow), superficial temporal (arrow), posterior auricular (arrow) and occipital (arrow). These are all branches of the external (not internal) carotid.
Case Discussion
These fistulae occur as a result of previous transverse sinus thrombosis with dural arterioles entering the sinus lumen to recanalize, creating multiple tiny fistulae, i.e. external carotid branches (supplying the dura) to transverse venous sinus.
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