Transcranial direct middle meningeal artery puncture for the Onyx embolization of dural arteriovenous fistula involving the superior sagittal sinus. Angiography depicts dural arteriovenous fistulas on superior sagittal sinus fed by middle meningeal arteries, superficial temporal arteries and occipital arteries and drained into the occluded SSS retrograde fashion. These lesions were approached with transcranial direct middle meningeal artery puncture after temporal bone decortication.