Treatment of a cavernous sinus dural arteriovenous fistula by deep orbitalpuncture of the superior ophthalmic vein

In a patient with progressive ophthalmological problems, including uncontro lled intraocular pressure related to a cavernous sinus dural arteriovenous fistula, urgent intervention may be necessary to prevent permanent visual l oss. We report a case in which inadequate transarterial embolisation and la ck of access for transvenous catheterisation, including a direct approach t hrough the superior ophthalmic vein, preceded percutaneous puncture of the superior ophthalmic vein deep within the orbit, permitting venous occlusion without complications. This case demonstrates that deep orbital puncture o f the vein is feasible for occlusion of a cavernous sinus dural arterioveno us fistula.