- BACKGROUND: Trans -arterial embolization (TAE) via the ophthalmic artery and middle meningeal arterial are the common arterial routes for anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs). However, TAE via the sphenopalatine artery (SPA) to treat ACF DAVFs is rarely reported. Here, we describe 14 cases of ACF DAVFs that were either treated solely or in conjunction with other arterial routes via the SPA. A total of 15 embolization attempts were performed via the SPA. - METHODS: Fourteen patients were treated with TAE via the SPA over a 20 -year period. There were 13 males and 1 female in total, with a mean age of 57.4 (57.4 +/- 6.0) years. The clinical presentation, angiographic features, treatment strategy, and clinical outcomes were all documented. - RESULTS: Fourteen patients with ACF DAVFs underwent TAE via the SPA. Complete immediate angiographic occlusion was achieved in 78.6% of the fistulas (11/14). Complete embolization via the SPA alone was achieved in 63.6% (7/11) of the fistulas. A total of 15 embolization attempts were performed via the SPA, with a 46.7% (7/15) success rate. After TAE via the SPA, no complications were found. 42.9% (6/14) of the patients had DSA or MRA followp. There was no recurrence of the fistulas. - CONCLUSIONS: The SPA may be as an alternative arterial route if other appropriate arterial routes are unavailable. However, its safety and efficiency need to be confirmed further.