Percutaneous Catheter Stabilization Maneuver ("Finger-Assisted" Technique) in Transvenous Cavernous Sinus Dural...

Cavernous sinus dural arteriovenous fistulas (CSdAVFs) pose technical challenges for transvenous embolization, particularly when the inferior petrosal sinus is inaccessible and transfacial venous routes are tortuous. We describe a "finger-assisted" technique involving percutaneous manual stabilization of the guide catheter microcatheter (GC-MC) construct to overcome instability during transfemoral transfacial navigation. A 33-year-old woman with progressive ocular symptoms and an angiographically confirmed Barrow Type D CSdAVF underwent transvenous embolization via the facial vein and superior ophthalmic vein. Initial microcatheter advancement was limited by GC-MC instability related to venous tortuosity. Manual counter traction was applied externally at the angle of the mandible, enabling controlled advancement of the catheter construct into the cavernous sinus. This facilitated precise coil embolization of the medial cavernous sinus compartment, followed by targeted transarterial glue embolization. Postprocedural angiography confirmed complete fistula obliteration, and the patient demonstrated rapid clinical improvement. This maneuver represents a simple, cost effective adjunct that provides additional catheter support without requiring invasive surgical access or additional devices. It may be particularly useful in resource limited settings or when conventional transfacial venous access is unstable. To our knowledge, this is the first formal description of percutaneous manual stabilization of a GC-MC construct during transfacial transvenous embolization of a CSdAVF.