We present a female patient with left eye hiperemia at 8 months. There was no prior history of trauma neither other complaints or symptons associated. The neurologic examination was normal except for marked hiperemia at left eye. There was no bruit. The CT scan revealed tortuous and dilated vascular structures at cortical surface of left temporal lobe. The digital subtraction angiography (DSA) revealed dural fistulae (DK) of the cavernous sinus type IV, with reflux through the superficial middle cerebral vein (SMCV) and venous ectasia, without drainage through superior oftalmic vein (SOV). Since there was no conventional endovascular access to the fistula, catetherization of SMCV by direct puncture and endovascular treatment was proposed. The procedure was performed under general anesthesia and the cranial drainage was completely excluded. The drainage became through the SOV and a small fistular component remained. One week later the treatment was completed, with obliteration of arterial afferents and functional exclusion of the DF.
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