Dural Arterio-Venous Fistulas (dAVF) located in the posterior fossa are a rare entity. Objectives of the study were to analyze the anatomy of the dAVF, their endovascular treatment strategies and clinical outcomes.

Two centers retrospectively selected patients treated between January 2009 and June 2018 for posterior fossa dAVF. We collected patient demographics, clinical presentation, arterial and venous outflow anatomy of the dAVF and treatment outcomes.

Twenty-six patients treated endovascularly for posterior fossa dAVF type III, IV or V, have been included. 100% of the dAVF were occluded: transarterial approach was performed in 23 dAVF (88.5%), combined transarterial and transvenous approach for 2 dAVF (7.7%) and transvenous approach alone for 1 dAVF (3.8%). Middle meningeal artery (MMA) was the most common artery chosen to inject embolic liquid (46%, 12/26). Procedure related morbidity was 15.4% at 24hours, 7.7% at discharge and 0% 6 months. Procedure related mortality was 0%.

Endovascular treatment offers high occlusion rates for posterior fossa dAVF with low morbi-mortality rates. Arterial approach is the first line preferred approach even if transvenous or combined approach can be a safe and effective option for patients with favorable anatomy.