Cavernous sinus dural arteriovenous fistula treated with transvenous embolization through facial vein: A case report

Background: Although the inferior petrosal sinus (IPS) is most common approach route for transvenous embolization (TVE) of cavernous dural arteriovenous fistulas (CSDAVFs), other routes should be chosen in cases which IPS occluded. We report a case superior ophthalmic vein (SOV) through facial (FV) was first choice to achieve radical cure hemorrhage-onset CSDAVF. Case Description: An 81-year-old female presented with history transarterial (TAE) and TVE left CSDAVF 27 years ago. She transported us chief complaint consciousness disturbance, head computed tomography (CT) showed subcortical hemorrhage right frontal lobe. Cerebral angiography revealed draining into SOV superficial middle cerebral (SMCV). Angiography, venography, contrast-enhanced magnetic resonance imaging did not show IPS, but outflow pathways SOV, FV, internal jugular were confirmed, so an FV selected. Conclusion: The selected femoral thanks distal access catheter (DAC) being guided microcatheter could easily SMCV (CS). performed, complete occlusion confirmed. When preoperative useful route, use DAC allowed treatment accurately quickly.