Midline supracerebellar infratentorial approach with clip occlusion of a straight sinus dural arteriovenous fistula.

Straight sinus dural arteriovenous fistulas (dAVFs), classified as tentorial type 2, can be approached with a torcular craniotomy and supracerebellar infratentorial approach, with gravity retraction from a sitting position optimizing the view. This video presents the case of a man in his early 60s with a thunderclap headache. Imaging showed a subarachnoid hemorrhage, and angiography confirmed a straight sinus dAVF. Endovascular embolization reduced flow, but further obliteration with surgical ligation was required. Intraoperative identification of the arterialized veins led to the fistula, and 2 efferent veins were clipped and divided. The patient tolerated the procedure well without new deficits, and angiography confirmed dAVF occlusion. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2586.