A 48-year-old pediatric nurse presented with a tension-type headache that had persisted for several months, along with new-onset right-sided pulsatile tinnitus. More recently, she also experienced intermittent diplopia. MRI revealed sinusitis, while angiography identified an abnormal venous compartment, leading to the diagnosis of a cavernous sinus dural arteriovenous malformation. Discover how the medical team managed to treat this complex malformation via a trans-venous approach, despite highly challenging access conditions.