Catheter positioned proximally within the left occipital artery. Angiography demonstrated a branch arising from the occipital artery which passed cranially through the jugular fossa and then posteriorly along the floor of the posterior cranial fossa towards the torcula. At the torcula there was a dural arteriovenous fistula with shunting into the superior and inferior vermin veins.
The branch supplying the fistula was felt to represent the 'jugular division' artery which normally arises from the neuromeningeal trunk but can arise from the occipital artery as an anatomical variant. The jugular division supplies CN IX, X, XI and dura of the posterior cranial fossa.
A microcatheter was navigated along the artery supplying the fistula to a position just proximal to the fistulous point. The fistula was embolized with a liquid embolic agent.
Repeat angiography demonstrated complete occlusion of the fistula with no residual shunting.