A168 Conservative ‘wait-and-see’ versus endovascular management of dural arteriovenous fistula of the hypoglossal canal: a single-center series of 12 patients

<h3>Introduction</h3> The treatment strategy for hypoglossal canal dural AVF (HC-dAVF) is controversial. Aim of Study to investigate when a conservative wait-and-see approach would be indicated or when an endovascular treatment is required. <h3>Method</h3> All HC-dAVF diagnosed at our institution between 2008 and 2024 were included. Patients were divided into a conservatively managed cohort-1 and an endovascularly treated cohort-2. Demographic data, clinical symptoms and imaging findings, were compared. Treatment strategies as well as the evolution of the patients and the dAVF (mRS and angiography) were analyzed. <h3>Results</h3> Two cohorts contained 6 patients each. In cohort-1, all patients and in cohort-2, 3 patients had a low grade AVF and suffered from pulsatile tinnitus (9/12 or 75%). 3/6 patients in cohort-2 suffered a hemorrhage, all Borden type III. Four of six (67%) conservatively treated cases evolved to a spontaneous occlusion. Transarterial embolization was performed with liquids in 5/6 patients; transvenous coiling in one case. Six-months’ angiography confirmed occlusion in 5/6 (83%) patients. One dissection of the middle meningeal artery provoked a transient facial nerve palsy. In cohort-2, all patients had a favorable functional outcome. <h3>Conclusion</h3> For Borden type I HC-dAVF, a conservative management seems justified because of a reasonable chance of spontaneous occlusion. For low grade, but highly symptomatic and for high grade hypoglossal canal dural AVF, transarterial and transvenous embolization is efficient and safe. Further research should provide more evidence for the reluctance to treat low symptomatic, non-ruptured hypoglossal canal dural AVF <h3>Conflict of Interest</h3> No