Embolization of indirect carotid cavernous fistulas via the vein of Labbé using contralateral approach

In our report, we present the case of a 60-year-old adult with symptomatic indirect carotid-cavernous fistulas (CCFs). All venous outflow routes from the cavernous sinus were absent except for an engorged left superficial middle cerebral vein, which extended through the left vein of Labbé to the left transverse sinus and then to right transverse-sigmoid sinus. We approached the diseased cavernous sinus retrogradely, starting from the right femoral vein and passing through the right transverse-sigmoid sinus, left transverse sinus, and left vein of Labbé, ultimately reaching the left CCFs. Embolization was performed using coils, successfully obliterating the fistulas without complications. This case represents the second reported approach through the vein of Labbé for CCFs and the first using a trans-Labbé vein from a contralateral approach (video 1), proving advantageous by avoiding an acute angle between the vein of Labbé and the ipsilateral sigmoid sinus.1-6 neurintsurg;18/2/604/V1F1V1Video 1Embolization of CCF using a Trans-Labbé vein from a contralateral approach.‍.