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Introduction Endovascular treatment options for dural arteriovenous fistula (DAVF) involving the transverse-sigmoid sinus include transvenous and transarterial embolization. However, in certain conditions such as venous stenosis or venous occlusion, transvenous embolization can be difficult to achieve. We report two cases of DAVF treated by transvenous embolization with balloon angioplasty via contralateral venous approach.Case Description Case 1: A 62-year-old male patient with a history of dural venous sinus thrombosis refractory to anticoagulant therapy presented with acute onset of aphasia and hemiparesis. Magnetic resonance imaging (MRI) revealed dilated cortical veins and cerebral edema. Angiography showed DAF with occlusion of ipsilateral transverse-sigmoid sinus and severe stenosis of contralateral transverse sinus.Case 2: A 57-year-old female patient presented with generalized seizure and deteriorated mental status. MRI and angiography showed DAVF of the left transverse-sigmoid sinus and the proximal segment of the right transverse sinus occlusion with massive cortical reflux.Endovascular approaches were attempted via the contralateral venous route. Mechanical dilatation or recanalization of the contralateral transverse sinus was achieved by balloon angioplasty.Conclusions In selected patients with serious intracranial hypertension due to massive cortical reflux, the treatment options should be considered not only to obliterate the fistula but also to restore a normal cerebral venous drainage. Contralateral venous approach with sinus angioplasty can be a viable option for management of DAVF.Conflict of Interest No