We report a case where a dural arteriovenous fistula (DAVF) was treated successfully with single-stage surgically assisted transcranial transvenous embolization. For this purpose, direct puncture of the transverse sinus was made with the patient in the prone position.Case Presentation: A 78-year-old female presented with pulsatile tinnitus and ataxia. Cerebral angiography confirmed the presence of a left transverse-sigmoid sinus DAVF with retrograde cortical venous reflux. As transvenous approach via the femoral vein was not possible, transcranial approach with direct puncture of transverse sinus was used for embolization of the fistula in the prone position with Prone View. Angiography demonstrated complete occlusion.Conclusion: Direct puncture of transverse sinus with Prone View may be considered a safe and effective approach when other approaches are not feasible.