Introduction: Dural arteriovenous fistulas (DAVF) are predominantly acquired abnormal connections between arterial and venous systems located within the dura. Most DAVF involve the Transverse-Sigmoid Sinus (TSS). Currently, the treatment strategies for DAVFs include endovascular therapy, microsurgery or stereotactic radiosurgery. Objective: In this video we will demonstrate endovascular trans-arterial embolization of DAVFs using detachable coils and ONYX-34 by using “Pressure cooker technique”. Procedure: Endovascular transarterial embolization of the dural arteriovenous fistula was done using liquid embolic agent Onyx 34 and detachable microcoils by first deploying the detachable microcoils proximally, creating a “pressure cooker effect” , followed by injection of Onyx into the fistulous connection using dimethyl sulfoxide (DMSO) compatible Apollo Onyx Delivery microcatheter (Medtronic) and Echelon 10 microcatheter ( Medtronic, Dublin, Ireland). Results: The procedure was uneventful with improvement in neurological status of the patient in follow up. Conclusion: Transarterial embolization is a feasible, safe and effective method for high flow dural arteriovenous fistulas with multiple arterial feeders.

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