To explore the treatment strategy for cases related to dural arteriovenous fistula with brachiocephalic vein variant.

A retrospective analysis of the clinical data of a patient with a clinical diagnosis of dural arteriovenous fistula admitted to the Neurosurgery Vascular Ward of Shenzhen Second People's Hospital, through interventional venous approach and intraoperative ultrasound-guided common jugular vein puncture and embolization dural arteriovenous fistula.

The right femoral vein puncture and venous approach were used. When the guide wire reached the brachiocephalic vein area, it was found that the guide wire could not reach the left brachiocephalic vein, and could not ascend to the lesion area through the brachiocephalic vein approach, which might have been caused by the variation of the left brachiocephalic vein; Ultrasound-guided jugular vein puncture was used to successfully embolize the dural arteriovenous fistula. Postoperative re-examination of the superior and inferior vena cava CT venography showed a variation of the left brachiocephalic vein (the left brachiocephalic vein directly returns to the right atrium).

The case of brachiocephalic vein variation is extremely rare. When interventional treatment through the venous route is required, CT venography of the superior and inferior vena cava or color Doppler ultrasound of the superior and inferior vena cava should be completed before the operation. The examination results can guide a better surgical method and reduce the surgical risk.