Transvenous Embolization of Olfactory Groove Dural Arteriovenous Fistula: A Case Series of Three Patients.

Olfactory groove or anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) are rare but highly aggressive lesions because of their direct cortical venous drainage and high risk of intracranial hemorrhage. Transarterial embolization (TAE) is commonly considered the first-line treatment; however, anatomical complexity or arterial limitations may make TAE technically difficult or unsafe. We present a case series of three patients with olfactory groove DAVFs successfully treated using transvenous embolization (TVE). In all cases, the fistulous point was accessed through the superior sagittal sinus and cortical bridging veins, allowing targeted coil embolization of the draining vein. Complete angiographic obliteration was achieved in all patients. One patient developed neurological deficits related to a thromboembolic event during arterial catheterization, while the remaining two patients had uneventful recoveries. Our experience suggests that TVE can be a feasible and effective treatment option for selected olfactory groove DAVFs, particularly in cases where arterial access is challenging or when previous transarterial treatment has failed.