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Introduction Intracranial dural arteriovenous fistulas (dAVFs) are pathological direct communications between meningeal arteries and venous sinuses or subarachnoid veins. Borden type III dAVFs are considered particularly high-risk anomalies because they exclusively exhibit retrograde cortical venous reflux. The firstline treatment is endovascular embolization, performed via either a transarterial or transvenous approach, with the goal of complete obliteration of arteriovenous shunting.Case Description A 69-year-old woman with a history of colorectal cancer and diffuse large B-cell lymphoma of the gastrointestinal tract presented with a two-month history of aphasia. Non-contrast CT imaging of the brain demonstrated confluent vasogenic edema of the left posterior cerebrum, initially concerning for an underlying mass. Follow-up MR and MRA imaging of the brain demonstrated abnormal increased signal of the left transverse sinus with adjacent enlarged serpiginous vessels and vasogenic edema in the left parieto-occipital-temporal region secondary to venous congestion. Selective left carotid angiogram demonstrated a left transverse sinus dural arteriovenous fistula supplied by feeding branches of the left extracranial carotid artery and cortical venous reflux into the vein of Labbe without evidence of dural sinous drainage, consistent with a Borden type III AVF. The patient subsequently underwent transarterial embolization of the dAVF using Onyx liquid embolic agent.Conclusions Endovascular treatment of intracranial dAVFs is dependent on location and venous drainage pattern. The presence of cortical venous reflux confers a higher risk of rupture, such as in the setting of Type III dAVFs. Transarterial embolization is the preferred management strategy for aggressive high-grade dAVFs.Abstract C110 Figure 1Borden type III dural arteriovenous fistula. (A) Axial T2-weighted MR image demonstrate abnormal increased signal of the left transverse sinus with adjacent serpiginous flow voids, consistent with dural AVF. (B) Lateral projection digital subtraction angiography of the left common carotid artery demonstrates a left transverse sinus dural AVF (blue arrow) with prominent cortical reflux into the vein of Labbe (orange arrow). (C) Arterial supply is noted from perforating transosseous branches of the left occipital artery (green arrow), ascending pharyngeal artery (red arrow), and posterior division of the middle meningeal artery. (D) Transarterial embolization of the left distal occipital artery (microcatheter, yellow arrow) was subsequently performed using Onyx liquid embolic agent.Conflict of Interest No