Introduction Sphenoidal dural arteriovenous fistulas (dAVF) are type III fistulas that could be either asymptomatic or symptomatic for venous hypertension or haemorrhagic presentation. Endovascular treatment (ET) is mostly taken into account for the cure of these lesions. Arterial approach using non-adhesive liquid embolic agents (NALEA) could be dangerous because of the frequent presence of ophthalmic artery dural feeders, potentially leading to central retinal artery embolization. Venous approach is not always feasible, because of extreme venous tortuosity. We present two cases of sphenoidal dAVF endovascularly treated with hybrid arterio-venous approach, consisting in a trans-arterial catheterization of the foot of the vein trough the proximal middle meningeal artery feeders, in order to avoid or minimize NALEA injection.

Case Description The first case is a 62 years old man with an asymptomatic left sided sphenoidal dAVF treated with transarterial access to the fistula foot of the vein, occluded with coils only. Second case is 65 years man with a right sided symptomatic sphenoidal dAVF, treated with same approach, adding limited amount of Onyx.

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Abstract P057 Figure 1

Results Hybrid arterio-venous approach for sphenoidal Davf could represent a promising technique in sphenoidal dAVF treatment in order to reduce both ophthalmic artery dangerous embolization and venous navigation risks.