Repeat computed tomographic angiography showed that the anterior portion of the superior ophthalmic vein had thrombosed, probably induced by the surgical manipulation (Figure 2A). A lateral orbital approach to reach the most posterior portion of the superior ophthalmic vein within the orbital apex was planned to achieve coiling. A superior eyelid-crease incision was made and extended temporally to expose the superior and lateral orbital rim. A superolateral marginectomy was performed. This allowed direct visualization of the superior orbital fissure. The periorbita was then incised between the lateral and the superior rectus muscles. With blunt dissection through the orbital fat, an enlarged arterialized superior ophthalmic vein was found. A silk suture was passed around it. A pediatric 3F Check-Flo Performer Introducer Set (Cook Medical, Bloomington, Indiana) was used to cannulate the superior ophthalmic vein, with the cannula's distal tip near the entry point to the cavernous sinus; the silk suture was tied to stabilize the cannula. The orbital rim was repositioned with 2 titanium plates, and the incision was sutured. The proximal end of the cannula was fixed to the skin with a suture, and the patient, who was under general anesthesia, was then transferred to the angiography unit (Figure 1D). Through a 5F sheath placed in the right common femoral artery, a diagnostic catheter was placed in the right internal and external carotid arteries and used for control injections (Figure 2B). Injections through the 3F cannula placed in the superior ophthalmic vein demonstrated a persistently patent dural fistula (Figure 2C). A renegade microcatheter (Boston Scientific, Natick, Massachusetts) was placed through the 3F cannula directly to the zone of arteriovenous shunting. Thereafter, 3 Micronester Coils (Cook Medical) were placed with dense packing in this area; the renegade catheter and the 3F cannula were removed. Control injections confirmed cure of the fistula (Figure 2D).