LAUSR

Cranial dural arteriovenous fistulae (dAVF) are rare cerebrovascular lesions characterized by direct arteriovenous shunting within the dural leaflets, with stark heterogeneity in angioarchitecture among different patients.1,2 It is, therefore, crucial to personalize treatment strategies to unique patients and their specific lesion. The authors describe an ethmoidal dAVF in an elderly female patient with arterial supply from the ophthalmic arteries and the contralateral middle meningeal artery. This, together with recent advances in microcatheter technology and the controllability of modern liquid embolic agents, opened up a route for transarterial embolization, obviating the need to course through the ophthalmic artery or the need for open surgery.3 Onyx is Food and Drug Administration-approved for treatment of arteriovenous malformations and can be used off-label for treatment of dAVF, as described here. This video demonstrates the technical nuances and safety considerations of transarterial liquid embolization through the middle meningeal artery while providing an overview of alternative treatment approaches for ethmoidal dAVFs. The patient consented to the procedure.