• Gahn Duangprasert, Suntaree Thitiwichienlert, and Dilok Tantongtip.
• Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand. Electronic address: gahn.md@gmail.com.
• World Neurosurg. 2022 Sep 1; 165: e412e422e412-e422.

BackgroundEndovascular therapy is the first-line treatment for the cavernous sinus dural arteriovenous fistulas, particularly transvenous embolization. This study aimed to assess the trans-superior ophthalmic vein approach to embolization for its safety, efficacy, and viability as a first-line treatment in selected patients, with a description of the microsurgical and endovascular techniques.MethodsWe retrospectively reviewed patients with cavernous sinus dural arteriovenous fistulas treated using the direct superior ophthalmic vein approach with n-butyl cyanoacrylate and coils as the main embolic materials from 2015 to 2021. The safety and efficacy of the treatment were evaluated based on ocular and neurological improvement, angiographic obliteration, and recurrence.ResultsOf the 16 patients, all cases were diagnosed with cavernous sinus dural arteriovenous fistulas. The n-butyl cyanoacrylate was used as the sole embolic material in 12 cases, and coils were used in 4 cases. A direct superior ophthalmic vein approach was selected as the first option in 11 patients. All the patients achieved complete fistula obliteration and good recovery from ocular symptoms, accompanied by excellent cosmetic results. No recurrence was observed at a mean follow-up period of 26 months.ConclusionsMicrosurgical dissection for exposure and direct cannulation of the superior ophthalmic vein as a route for fistula obliteration delivers excellent clinical outcomes, with a low rate of complications. Not only is it safe and effective as an alternative approach but it can also serve as first-line treatment in selected patients.Copyright © 2022 Elsevier Inc. All rights reserved.

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