0:01

So, uh, the next one is the patient. It was actually a very interesting case.

0:03

This patient presented with Pulsitile tinnitus on the right side.

0:07

This was an unusual case.

0:09

I think the imaging findings were relatively straightforward,

0:11

but it was kind of rare to see a case like this,

0:13

but it does demonstrate the nice vascular anatomy.

0:16

So the normal anatomy on the left hand side,

0:18

on the left side is that this is gonna be the normal parotid gland here.

0:22

Here's a retro Dior vein, and this is gonna be the internal maxillary artery.

0:26

So on the right hand side,

0:27

what we see are just multiple dilated vessels on the right,

0:32

and I have to admit,

0:33

it gets a little bit challenging to figure out where the internal maxillary

0:35

arteries, the retro Dior vein is. But if you see my cross here is like this,

0:41

I think this is gonna be the MIB vein here.

0:45

And then just deep to this is the internal maxillary artery.

0:48

So they ended up doing the angiogram.

0:50

And the angiogram demonstrated an I m a fistula.

0:53

So there's actually a direct fistula between the internal maxillary artery and

0:58

the vein.

0:58

So this is actually a nice depiction here of where the internal maxillary artery

1:02

runs.

1:03

It runs right here into the al Palatine fossa after it branches off from the

1:07

external carotid artery.

1:09

So the reason the patient presented with puls tinnitus is because this i m a

1:12

fistula. So the high flow was both from the arterial face and the venous face.

1:19

So I'll stop there and see if you guys have any questions on this one.

1:24

In this case, it,

1:25

it wasn't like a congenital fistula or like any other cause was

1:30

there?

1:30

Yeah, that's a great question. I think this was just a congenital fistula.

1:34

I don't think the patient had any history of trauma and didn't have any history

1:38

of neoplasm either. So it was a very unusual case of a,

1:41

of a congenital fistula. Crazy case. Will you show,

1:46

will you show me, show us the,

1:48

The angiogram.

1:49

This is the, uh, it's the can and everything,

1:52

but here's the angiogram right here. So here's the catheter.

1:55

So this is that one case we showed. Here's the artery and there's the vein.

1:58

So the fistula is probably right in here 'cause there's the art,

2:01

there's the artery here,

2:05

and then there's the vein.

2:06

So I think the fistula would probably be right about there.

2:08

Let's just see if we have any more images showing it. Here's the post-treatment.

2:15

So here's a bunch of coils. You can see they coiled, uh,

2:18

looks like they coiled the venous side of the system.

2:22

And then you can see the slow flow in the artery here.

2:25

There's a little bit of reflux in the internal carotid.