| Summary: | Background: Dural arteriovenous fistulas (DAVF) within the anterior cranial fossa (ACF) are of particular concern due to their higher hemorrhage rates. Surgical intervention is typically the most effective treatment for ACF DAVFs, although recent advancements suggest increasing use of endovascular techniques. It has consistently shown effectiveness, with minimal thromboembolic risks. Case description: We present two cases of ACF DAVF graded Cognard type IV. A successful pterional and frontotemporal approach was performed, respectively. Postoperative angiography confirmed complete DAVF occlusions, and the patients had an uneventful recovery. Conclusion: ACF DAVFs can be exposed through direct or indirect approaches, with advantages and drawbacks for each method. The anterior interhemispheric approach is widely recognized for its safety and efficacy. Limited studies have advocated for the use of the pterional approach, showing feasibility and potential benefits such as avoiding frontal sinus reconstruction and providing an excellent view of the fistula. Furthermore, pterional approach offers sufficient exposure and favorable cosmetic outcomes, making it a viable option for ACF DAVFs. The presented cases exemplify the efficacious surgical management of ACVF DAVFs through distinct approaches, underscoring the significance of personalized treatment strategies and the effectiveness of surgical interventions in accomplishing total obliteration of the fistulas.
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