Article ID: cr.2022-0029
Objective: Herein, we report a case of cavernous sinus dural arteriovenous fistula (CSDAVF) treated with transvenous embolization and surgical cannulation of the superior ophthalmic vein (SOV).
Case Presentation: A 61-year-old man with a 4-month history of progressive orbital congestion, exophthalmos, achromatopsia, and high intraocular pressure in the right eye was diagnosed with right CSDAVF using angiography. We attempted embolization via the inferior petrosal sinus and facial vein twice. However, both attempts failed as focally thrombosed, narrowed, and tortuous vein prevented insertion of the microcatheter into the cavernous sinus. Surgical exposure of the SOV allowed its direct cannulation via the orbital septum. The fistula was embolized through the SOV with platinum coils without complication, improving patient’s symptoms.
Conclusion: Surgical cannulation of the SOV via an opened orbital septum to resolve CSDAVF is a safe and effective approach when conventional transvenous access fails.
