• Yosuke Akamatsu, Yoshitaka Kubo, Kohei Chida, Yasushi Matsumoto, and Kuniaki Ogasawara.
• Department of Neurosurgery, Iwate Medical University, Morioka, Japan. Electronic address: redpine7219@gmail.com.
• World Neurosurg. 2020 Sep 1; 141: 15-19.

BackgroundIntraorbital arteriovenous fistulas (AVFs) are rare lesions, and their treatment is challenging. We have presented a case of an intraorbital AVF treated with endovascular embolization through the surgically accessed basal vein of Rosenthal.Case DescriptionA 53-year-old man had been referred to our hospital for an aneurysm-like lesion that was compressing the left optic chiasm. A left internal carotid angiogram demonstrated an orbital AVF fed by a distal segment of the ophthalmic arteries and the anterior branch of the inferolateral trunk that was drained solely into a tortuous basal vein of Rosenthal through a bridging vein of the left optic nerve sheath. Considering the risk of hemorrhagic complications during transvenous manipulation and visual complication in cases of transarterial embolization, combined surgical and transvenous embolization was attempted through the translocated basal vein of Rosenthal to bypass the dangerous path to the fistula. The lesion was directly catheterized through the translocated basal vein of Rosenthal after confirming visual tolerance to brief drainage occlusion using visual evoked potential monitoring, resulting in successful fistula obliteration using detachable coils.ConclusionDirect catheterization of the translocated deep draining vein was useful to bypass the dangerous access to the fistula and could be a feasible alternative strategy for treating selected AVFs.Copyright © 2020 Elsevier Inc. All rights reserved.

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