A 62-year-old woman with 1 episode of seizures. A–C, Type IV DAVF of the vein of Galen draining into multiple dilated veins to the superior sagittal sinus. The straight sinus was occluded. D and E, Distal catheterization of the right MMA allowed injection of 11 mL of Onyx in 48 minutes, with retrograde occlusion of other feeders, occlusion of the venous pouch, and no migration into cortical veins. F and G, Postoperative 3-month assessment shows complete fistula cure.