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We read with great interest the article by Pathuri et al,1 entitled ‘Treatment of intraorbital arteriovenous fistulas with direct puncture: a case series and review of treatments since 1978,’ published in the Journal of NeuroIntervention Surgery. The study provides valuable insights into the treatment of intraorbital arteriovenous fistulas (IOAVFs) using direct puncture (DP) and offers a comprehensive review of various treatment modalities since 1978.