Dural arterio-venous fistula in posterior fossa: pulsatile tinnitus

Case contributed by Dr Chris O'Donnell


Assymetrical hearing loss and pulsatile tinnitus for some months.

Patient Data

Age: 65
Gender: Male

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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Case information

rID: 38000
Published: 1st Jul 2015
Last edited: 3rd Jun 2020
Inclusion in quiz mode: Included

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