In transvenous endovascular treatment of dural arteriovenous fistula (AVE), access to the affected sinus is determined by venous drainage. In cavernous dural AVF, the route to the cavernous sinus is through the inferior petrosal sinus (IPS) or the superior ophthalmic vein. Other venous routes are not practical. Occlusive change of the IPS is a common finding. The transfemoral approach is not always easy because of obliteration of the IPS. In selection of the approach for the transvenous treatment of the cavernous dural AVF, these occlusive changes should be considered.
