Endoscopic Disconnection of Jugular Foramen Dural Arteriovenous Fistula Using Superselective Intra-arterial Indocyanine Green Videoangiography

Jugular foramen dural arteriovenous fistulas are exceedingly rare vascular abnormalities, with only 10 cases documented so far. Their complex angioarchitecture and the risk of postoperative complications necessitate carefully planned treatment strategies. We present the case of an 82-year-old man who presented with transient dizziness. Digital subtraction angiography revealed a Cognard type V dural arteriovenous fistula at the right jugular foramen, fed by the neuromeningeal branch of the right ascending pharyngeal artery and draining into the perimedullary veins of the brainstem and spinal cord via a single right inferior petrosal vein. The lesion was successfully treated in a hybrid operating room using a multimodal approach. The procedure involved continuous neurophysiological monitoring and endoscopic disconnection of the draining vein, guided by superselective intra-arterial indocyanine green videoangiography. Complete disconnection was confirmed intraoperatively by digital subtraction angiography. To our knowledge, this is the first report of endoscopic disconnection of a jugular foramen dural arteriovenous fistula, specifically performed using intra-arterial indocyanine green videoangiography in a hybrid operating room. The combination of minimally invasive neuroendoscopy with superselective intra-arterial indocyanine green videoangiography provides both safety and effectiveness in the treatment of dural arteriovenous fistulas. This approach may be particularly advantageous for lesions in rare and anatomically complex regions such as the jugular foramen.