Objectives To analyse the outcome of this novel approach in patients with Caroticocavernous fistulas (CCFs) and to compare it with the commonly used transvenous pathway.

Design Retrospective analysis of patients with CCFs treated using the transorbital approach.

Subjects 10 patients were identified following review of inpatient databases and collection of information for those treated offsite.

Methods Analysis of Angiography findings and follow up imaging alongwith review of outcomes from patient records (Using TO approach, coils were used over liquid embolic due to risk of reflux of liquid from perforators).

Results No failure to puncture No orbital hematoma requiring drainage/canthotomy Occlusion rate 100% Commonest symptoms of eye pain and proptosis (all subjects) with chemosis, opthalmoplegia and reduced visual acuity (fairly common) in the patients studied improved significantly post the TO procedure with transient 3rd and 4th Nerve palsy being the only complication.

Conclusions Transorbital approcah (TO) is a safer, acceptable alternative to the catheter transveous approaches for CCFs (dural and direct) With greater numbers and experience, TO could be considered as a 1 st line approach.