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Objective: The first choice for the treatment of cavernous sinus dural arteriovenous fistula (CSdAVF) is transvenous embolization. The inferior petrosal sinus (IPS) approach is commonly used, but modification of the procedure is necessary in patients with IPS occlusion. We treated one patient by guiding a distal access catheter (DAC) to the cavernous sinus by the transfacial vein approach through the superior ophthalmic vein and obtained a favorable outcome. Case Presentation: A 68-year-old woman with CSdAVF presented with ophthalmic symptoms. All feeding arteries converged in a pouch on the superior aspect of the medial posterior segment, and the superior ophthalmic vein/facial vein was the only drainage route. A 3.4 Fr TACTICS used as a DAC in a triple coaxial system was placed in the cavernous sinus via the facial and superior ophthalmic veins, a micro-catheter was navigated to the shunted pouch, and CSdAVF was embolized with two coils. Conclusion: 3.4 Fr TACTICS is useful as a DAC in the transfacial vein approach to CSdAVF through the superior ophthalmic vein.

A Case of Cavernous Sinus Dural Arteriovenous Fistula Treated by Transfacial Vein Placement of a Distal Access Catheter in the Cavernous Sinus