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In this retrospective study of 20 patients, the authors report the results of imaging-guided percutaneous superior ophthalmic vein access in dural carotid cavernous fistula treatment. Minimally invasive percutaneous imaging-guided access to the SOV can be obtained in situations in which conventional transvenousaccess to the cavernous sinus is not possible for managementof patients with dural carotid cavernous fistula. The authors conclude that direct imaging-guidedpercutaneous SOV access is a valuable and time-savingalternative route compared with direct surgical SOV access.