Abstract
Dural arteriovenous fistulas (DAVF's) of the cavernous sinus are curable by endovascular means in the vast majority of cases. Both transarterial and transvenous approaches by femoral route can be used for closure. In rare cases with unsuitable anatomy or angioarchitecture, an endovascular approach is proposed by open surgical exposure of a major venous outflow, e.g. the superior ophthalmic vein. We report on a case of unsuccessful attempts at transarterial and transvenous catheter navigation through traditional endovascular routes, where surgical exposure of the major cortical venous drainage was necessary. A direct puncture of the sylvian vein allowed placement of a microcatheter in the cavernous sinus and occlusion of the fistula by coils.