C24 Transarterial onyx embolization of a case of posterior condylar canal dural arteriovenous fistula presented with subarachnoid hemorrhage

<h3>Introduction</h3> Posterior condylar canal dural arteriovenous fistula (PCC DAVF) is a rare entity and reported cases have been treated by transvenous embolization. PCC DAVF with subarachnoid hemorrhage (SAH) like ours is extremely rare. We would like to share our successful treatment experience of PCC DAVF through transarterial glue embolization. <h3>Case Description</h3> A 51-year-old female presented with sudden-onset severe headache. Computed tomography angiography (CTA) showed SAH, intraventricular hemorrhage and strong enhancing vascular structure at the prepontine cistern (figure A, B). Digital subtraction angiogram revealed the left side of PCC DAVF (figure C, D). The venous drainage was through the ipsilateral medullary bridging vein. Transarterial Onyx embolization was initially performed via the dural branch of the vertebral artery, but Onyx wasn’t penetrated to the fistula point (figure E, F). In addition, Onyx embolization was performed via the neuromeningeal trunk of the ascending pharyngeal artery (figure G, H). Post-embolization angiogram and CTA showed no more shunts and pathologic dilated medullary vein (figure I~L). After embolization, the patient recovered without neurologic deficit. <h3>Conclusions</h3> Treatment of reported PCC DAVF was used via transvenous embolization. However, transvenous embolization isn’t impossible when shunt drains into a dilated, tortuous medullary bridging vein. Transarterial Onyx embolization can be a treatment option, and lower cranial nerve injury through dangerous anastomosis should be considered. <h3>Conflict of Interest</h3> No