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+A 48-year-old man presented at our hospital complaining of intracranial bruits.
+The cranial nerve and laboratory examinations were normal.
+A DVAF was considered, conventional digital subtraction angiography was performed, which showed a Cognard II DVAF in the location of right hypoglossal canal (HC).
+The DVAF was fed by the meningeal branches of the bilateral ascending pharyngeal arteries, and the right anterior condylar veins within the hypoglossal canal that was the fistulous point mainly drained into the jugular vein.
+Endovascular treatment was insisted upon by the patient because of the associated intolerable intracranial bruit.
+Treatment was performed by transarterial approach under general anesthesia using a biplane angiographic unit.
+Standard coaxial techniques were used.
+The guide catheter was navigated into the left ascendingtrawt pharyngeal artery.
+Marathon flow directed catheter (eV3) was subsequently navigated over a Mirage.008 microwire (eV3) to reach as near as possible to the fistula.
+The microcatheter was flushed with 10 mL of normal saline.
+The dead space of the microcatheter was subsequently filled with dimethyl sulfoxide (DMSO).
+Onyx-18 was then injected over two minutes to fill the microcatheter and to replace the DMSO in the dead space.
+The injection was stopped until unwanted flow into branches of the right ascending pharyngeal artery was observed.
+The follow-up angiogram showed no residual shunt (Figure ​1).
+The intracranial bruits disappeared immediately after the operation.
+For the toxicity of DMSO, 10 mg dexamethasone was intravenously injected for three days.
+On the second day after endovascular treatment, the patient complainted of difficulty moving his tongue to the left.
+Cranial nerve examination was only significant for a right hypoglossal nerve palsy.
+The patient was discharged from our hospital four days after treatment without continuative pharmacotherapy.
+At two months follow-up, the patient's main complaint were difficulty swallowing (dysphagia) and slurred speech (dysarthria).
+In addition, his tongue deviated toward the right during tongue protrusion, and marked right-sided hemiatrophy was observed (Figure ​2).
+The cranial nerve examation showed right hypoglossal nerve palsy persisted.
+We telephone the patient at three months follow-up and requested a vocal cord evaluation by an ENT specialist in a local hospital.
+Vocal cord paralysis was not found, and there was no evidence of vagus nerve dysfunction.
+Oral Vitamin B12 was used and his prognosis was still at a long follow-up.