Abstract Introduction Embolization via the transvenous route is an established treatment for cavernous sinus (CS) dural arteriovenous fistula (DAVF). Among transvenous approaches, the trans-middle temporal vein (MTV)-superior ophthalmic vein (OphV) route is less commonly employed but represents a viable alternative. However, associated superior OphV stenosis can result in postoperative periorbital swelling secondary to impaired venous drainage. A rare case of this complication is reported. Case presentation A 71-year-old woman presented with a two-month history of swelling and redness in the right eye. One month earlier, she had undergone an unsuccessful transvenous embolization through the inferior petrosal sinus. On examination, swelling of the upper eyelid and conjunctival congestion were noted in the right eye. Under general anesthesia, angiography revealed a CS DAVF with MTV drainage. The trans-MTV-OphV procedure was subsequently performed. A 6 F supporting catheter was placed in the right brachiocephalic vein, followed by successful advancement of a 4.6 F distal access catheter into the MTV. The arterial roadmap demonstrated a stenotic superior OphV. A microcatheter was then navigated through the stenotic OphV and advanced to the origin of the OphV, where coiling and Onyx casting achieved complete obliteration of the DAVF. Postoperatively, the patient developed periorbital swelling secondary to stenosis and impairment of the OphV. Prednisolone (500 mg once daily) was administered for three days, leading to the resolution of the periorbital swelling. Conclusion In cases of CS DAVF, the trans-MTV-superior OphV approach may represent a viable venous access alternative. However, superior OphV stenosis can result in postoperative periorbital swelling, resulting in impaired venous drainage. Glucocorticoid therapy may be effective in managing this complication.

The persistence of infectious diseases poses a continued threat to health security across Africa, revealing deep-rooted challenges in achieving effective transnational collaboration. The COVID-19 pandemic has exposed both the potential and limitations of transnational collaboration in Africa’s infectious disease response. While regional mechanisms such as the African Vaccine Acquisition Task Team (AVATT) demonstrated that collective action can achieve significant results when political will is mobilized, persistent challenges in surveillance, data sharing, and capacity building reveal deeper structural barriers to sustained collaboration. This review examines transnational collaboration in Africa through the lens of political determinants, analyzing how politics, agency, and will interact to shape collaborative outcomes in infectious disease response. We conducted a review of literature published between 2020 and 2024, supplemented with grey literature from regional organizations, yielding 40 articles that inform a scorecard analysis of COVID-19 response across three domains: Information and Laboratory Systems (prevention phase), Vaccine Deployment and Development (vaccination phase), and Response Coordination and Public Health Research Capacity (control/elimination phase). Our analysis reveals two key patterns: the Paradox of Agency, whereby strong individual state and local action coexist with weak collective transnational mechanisms, and the Governance-Capacity Loop, whereby political fragmentation perpetuates capacity gaps that in turn reinforce governance weaknesses, which together provide a novel analytical framework for understanding the political determinants of health security in Africa. The scorecard demonstrates that challenges are systemic and political rather than disease-specific: similar patterns of fragmented collaboration, sovereignty concerns, and financing gaps emerge across COVID-19, Ebola, mpox, and cholera responses. While Africa has exercised reactive sovereignty mobilizing crisis-driven responses, it has not yet achieved structural sovereignty: the embedded capacity and political commitment for sustained, African-led health security governance. We propose a roadmap for strengthening transnational collaboration through sustained investment in regional data governance, vaccine manufacturing capacity, health diplomacy mechanisms, and African-led financing frameworks. This analysis demonstrates that effective transnational collaboration requires not only technical capacity but fundamental political transformation: from fragmentation to coordination, from reactive crisis response to proactive capacity building, and from external dependence to African ownership of health security agendas.