Far-lateral craniotomy for obliteration of foramen magnum dural arteriovenous fistula

A 63-year-old woman with a history of stroke underwent further workup. MRI revealed a region of asymmetrical ASL hyperintensity near the right hypoglossal canal. Angiogram revealed a left foramen magnum region dural arteriovenous fistula supplied by a left V4 vertebral artery branch, with early draining veins into the skull base and left sigmoid sinus. Attempts were made to catheterize the fistula, but it was not amenable to endovascular intervention. A far-lateral craniotomy with C1 hemilaminectomy was performed, with obliteration confirmed on postoperative DSA. At 2-year follow-up, the patient remained at her neurological baseline with no evidence of recurrence. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2579