OBJECTIVE: We report an interesting case of a right temporal pre-auricular 
arteriovenous fistula (cirsoid aneurysm) causing intractable tinnitus 
successfully managed by transarterial n-butyl cyanoacrylate glue embolisation.
CASE REPORT: A 52-year-old female presented with a one-year history of tinnitus 
and pulsatile swelling in the right pre-auricular region. A colour Doppler 
ultrasound test and magnetic resonance angiography revealed a high-flow scalp 
arteriovenous fistula with a feeder vessel from the distal superficial temporal 
artery, which drained into the corresponding, dilated, tortuous vein. The 
patient underwent diagnostic digital subtraction angiography. This was followed 
by transarterial embolisation of the fistula using a 50 per cent mixture of 
n-butyl cyanoacrylate glue and Lipiodol®, with manual distal venous occlusion. A 
successful outcome was achieved with instant relief of symptoms.
CONCLUSION: Cirsoid aneurysms of the facial region, an uncommon cause of 
tinnitus, can be effectively managed by endovascular embolisation. This 
treatment obviates the need for surgery, which is associated with an increased 
risk of complications such as scarring, deformity and bleeding.