Abstract
BACKGROUND: In dural arteriovenous fistulas, bridging veins are connecting vessels that drain venous blood from the surface of the brain to the surrounding dural sinus. It is rare for the fistulous point and the bridging vein to be at different levels. OBSERVATIONS: A 71-year-old man presented with progressive spinal symptoms of 8 months' duration. Angiography showed that the jugular branch of the ascending pharyngeal artery was the feeding artery, with the fistulous point at the jugular foramen and the bridging vein at the foramen magnum level, draining into the spinal vein. Direct surgery was performed via a transcondylar fossa approach, allowing visualization of both the fistulous point and the bridging vein, and successful venous outflow occlusion was achieved. The surgery was completed without complications, and the patient's spinal symptoms gradually improved over time. LESSONS: For jugular foramen dural arteriovenous fistulas with a bridging vein at the foramen magnum level, a direct surgical approach via the transcondylar fossa, which allows visualization of both the fistulous point and the bridging vein, was useful for achieving a safe and definitive occlusion. https://thejns.org/doi/10.3171/CASE25477.