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80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

20.05. - 24.05.2009, Rostock

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Arterio-venous dural fistula – an important differential diagnosis in puls-synchronious tinnitus

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German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno035

doi: 10.3205/09hno035, urn:nbn:de:0183-09hno0359

Published: July 22, 2009

© 2009 Waller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Introduction: In case of a puls-synchronious tinnitus one has to consider a vascular lesion close to the skull base or in the vicinity of the temporal bone. Introducing a typical clinical case adequate diagnostic and therapeutic methods for an arterio-venous fistula in this very localisation are to be presented.

Case: A 28-year old female patient has been referred for evaluation of a right sided pulsatile tinnitus experienced during physical exertion for the first. Additionally, she described a hemicranial headache on the right side. On examination a pulsating venous vessel on the right mastoid bone could be found. Auscultation of this vein revealed a machine-like noise. MRI-angiography showed a dural arterio-venous fistula close to the sigmoid sinus. Performing a highly selective angiography the corresponding vessels could be embolised sufficiently by instillation of microparticles. After this intervention the patient’s tinnitus as well as the headache disappeared completely.

Discussion: Today neuroradiological expertise in inevitable, when it comes to examinate and treat a pulsatile tinnitus. The need for interventional angiography with embolisation depends on the subjective complaints of the patient on the one hand and the risk for intracranial haemorrhage caused by rupture of such a vascular malformation on the other.