Successfully Creating a Roadmap Using 3D Polyline During Transvenous Embolization of Anterior Condylar Arteriovenous Fistula: A Case Report

Matsui M, Saito O, Tokuyama S and Tenj H

Published on: 2025-05-20

Abstract

Objective

Anterior condylar arteriovenous fistula (ACAVF) is a rare type of intracranial AVF with intraosseous shunt, for which transvenous embolization (TVE) is an effective treatment. However, catheterization can be problematic, owing to its anatomical characteristics. Herein, we report a case in which we created a roadmap using the 3D polyline function, solved the catheterization problem, and successfully performed treatment.

Case Presentation

A 46-year-old man with ACAVF presented with a disturbance in his right eye movement. Right external carotid angiography revealed that feeding came mainly from the right ascending pharyngeal artery, convergence into the intraosseous venous pouch of the right condyle, reflux into the cavernous sinus and sigmoid sinus via the anterior condylar confluence. The drainage route around the shunt point was unclear, owing to the complex vascular anatomy and overlapping of vessels in the lesion. However the multiplanar reconstruction images obtained via 3D rotational angiography showed a clear drainage route around the venous pouch. We determined that treatment with TVE was possible. At the preoperative stage, the 3D polyline function was used to plot the drainage route from the venous pouch to the internal jugular vein, allowing for a 3D depiction of the access route. The 3D polyline function was also used intraoperatively to plot the access route from the catheter tip to the venous pouch, yielding a roadmap that allowed us to perform the operation smoothly.

Conclusion

The 3D polyline function is useful for creating roadmaps in cases with overlapping vessels or complex access routes.