Endovascular occlusion of external carotid artery: internal jugular vein fistula via direct transcranial access to transverse-sigmoid sinus.

Endovascular transarterial or retrograde transvenous occlusion is the preferred modality for treatment of dural arteriovenous fistulas at most intracranial locations. However, transvenous navigation to the segment of interest might not be possible due to occlusion or stenosis of an extracranial or intracranial major venous channel. Direct transcranial access to a major venous sinus proximal to the occlusion is a useful strategy in such situations. This video demonstrates successful endovascular coil embolization of an external carotid artery-internal jugular vein fistula below the jugular foramen through direct transcranial access to the transverse-sigmoid sinus in a patient with bilateral internal jugular vein occlusion. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2537.