Ear ischemia induced by endovascular therapy for arteriovenous fistula of the sigmoid sinus: A case report

Abstract

BACKGROUND Arteriovenous fistula of the sigmoid sinus is an abnormal connection of arteries with the sigmoid sinus. Endovascular treatments of such lesions are consideredsafe and with low rates of complications.CASE SUMMARYA 62-year-old female patient underwent endovascular treatment of an arteriovenousfistula of the right sigmoid sinus on February 7, 2017, but her tinnituswas not cured. She was admitted to the Beijing Tiantan Hospital, Capital MedicalUniversity, on March 20, 2017, and her pre-operative diagnosis, by digitalsubtraction cerebral angiography, was arteriovenous fistula of the sigmoid sinus.She underwent endovascular embolization of the distal occipital artery andposterior auricular artery using Onyx-18. The arteriovenous fistula of the sigmoidsinus was cured, and her tinnitus disappeared, but ischemia of the upper 2/3 ofthe right auricle occurred without hearing loss. The patient received treatment toimprove microcirculation, in addition to fluid supplementation, analgesia, andhyperbaric oxygen, and the swelling due to ischemia in the right auricle did notprogress further. The patient reported no tinnitus, and the right auricle hadreturned to normal 3 years later.CONCLUSIONIschemic complications of vital organs should be considered when performingembolization procedures for arteriovenous fistulas of cerebral sinuses.Compensation of the organs should be evaluated before the operation, and therelated treatment regimens should be planned