20977862 Visualization

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