Middle temporal vein approach for transvenous embolization of cavernous sinus dural arteriovenous fistula: A Case Report

Transvenous embolization (TVE) is the preferred treatment for cavernous sinus (CS) dural arteriovenous fistula (dAVF), typically accessed via the inferior petrosal sinus (IPS). In cases where the IPS is inaccessible, alternative routes are required. We report a case of an 87-year-old female with left conjunctival hyperemia and exophthalmos due to the left CS dAVF draining into the superior ophthalmic vein. Because of the IPS occlusion and severe facial vein tortuosity and stenosis, TVE was performed via the middle temporal vein (MTV). This case demonstrates the feasibility and effectiveness of the MTV route for TVE in challenging CS dAVF cases.