Pulsatile Tinnitus Caused by Dural Arteriovenous Fistula

Hi my name is Chris and I have had pulsatile tinnitus since November 2017. Cut a long story short in Augugust 2018 I had a cerebral angiogram which confirmed a dural arteriovenous fistula. The stage I am at now is I have another appointment next week to discuss embolisation as at first I was told could wait 7 months for tinnitus masker (first plan was to try one for 3-4 months to see if it helps) so I asked if just fixing it is an option and have an appointment next week to talk to a consultant properly.

Anyone else similar? I did agree that trying tinnitus masker is an option but then from another view I am 29 years old and ENT reckons at some point I will need it embolised but neuro interventional radiologist who did the angiogram reckons first instance should be the tinnitus masker because it's only type 1 and classes as benign.

Any advice would be helpful.

Regards
Chris

 

How did you make out? I have had two DAVF treated.

 

Clinical analysis of 5 cases of dural arteriovenous fistulas complained of pulsatile tinnitus

Abstract

Objective: The clinical characteristics of dural arteriovenous fistula with pulsatile tinnitus were analyzed to deepen the understanding of the disease. Methods: The clinical data of five patients complained of pulsatile tinnitus and diagnosed dural arteriovenous fistula in Henan People's Hospital from May 2013 to June 2018 were retrospectively analyzed, including 3 males and 2 females, aged 27-65 years. Results: The main clinical symptoms of the five patients were continuous pulsatile tinnitus, accompanied/not accompanied by headache, memory decline, etc., with a course of three months to 20 years. They were diagnosed as dural arteriovenous fistula by digital subtraction angiography, and three cases of tinnitus disappeared and two cases of tinnitus were relieved after embolization. Conclusions: The dural arteriovenous fistula is a rare and complicated disease. When the patient complain of the pulsatile tinnitus, the related etiology should be considered and managed properly.

Source: https://www.ncbi.nlm.nih.gov/pubmed/31954389

 

The natural history of DAVF is poor. Meaning, at some point they cause a blood vessel to rupture, or seizures, or other symptoms. They tend to only get worse, and almost never improve or go away on their own. I've had 4 in less than 2 years. You really should have it embolized. And it's important to not just go to anyone. It's important to go to someone who toward the top of their field at this, since they are so rare. The surgery isn't a big deal. It's definitely worth it.

 

Microsurgical treatment of intracranial dural arteriovenous fistulas. Case series and review of the literature

Objective ‒ to evaluate peculiarities and results of microsurgical treatment of intracranial dural arteriovenous fistulas (DAVF).

Materials and methods. A retrospective analysis of microsurgical treatment of 7 patients with DAVF (4 (57. 1%) women and 3 (42.9 %) men, average age ‒ 43.4 years), who were hospitalized and surgically treated at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» from 2016 to 2020, was made. DAVF was drained into the superior sugittal sinus in 4 (57.1 %) patients, transverse and sigmoid sinuses in 2 (28.6 %) cases, in the middle cranial fossa in 1 (14.3 %). According to the Cognard classification there were 3 (42.9 %) DAVFs belong to type IIb, 2 (28.6 %) ‒ to type IIa + b, 1 (14.3 %) DAVF ‒ to type II, 1 (14.3 %) DAVF ‒ to type IV.

Results. In 3 (42.9 %) patients were primarily treated with endovascular method. Follow up studies revealed a recurrence of the disease, and microsurgical disconnection was performed. In 4 (57.1 %) cases, endovascular access to superficial DAVF was risky due to anatomical features, and microsurgery was preferred. In all patients, surgical treatment aimed the disconnecting of the shunt. In 1 (14.3 %) case of DAVF the transverse sinus was ligated. In all cases angiographic confirmation of the DAVFs exclusion was performed. In the postoperative period, there was no evidence of an increasing of clinical symptoms. All patients with pulsatile tinnitus and headache noted their regression after surgery.

Conclusions. Considering the efficacy of modern endovascular techniques, microsurgery of DAVF has been indicated in cases where endovascular embolization has proven to be no-n-efficient or technically impossible. Among surgical methods of DAVF treatment, there are disconnection of the meningeal arteries directly at the site of the fistula, resection of the abnormal dura mater with feeding vessels, ligation and intersections of the injured venous sinus, skeletonization of the sinus with the feeding dural vessels. Treatment should be performed in all cases of DAVF with cortical venous drainage and progressive symptoms of the disease. The choice of optimal treatment should be made in a multidisciplinary manner, and all possible methods should be taken into consideration.

Source: https://enj.org.ua/index.php/journal/article/view/138

 

See in the full article a case study of a pulsatile tinnitus due to a dural arteriovenous fistula and treated by gamma knife radiosurgery

Gamma Knife Radiosurgery: The Gold Standard Treatment for Intracranial Dural Arteriovenous Fistulas without Cortical Venous Drainage

Full article: https://www.neurologyindia.com/arti...68;issue=4;spage=815;epage=820;aulast=Sardana