Dural arteriovenous fistula involving the superior petrosal vein (SPV DAVF) is an extremely rare condition. Therefore, its clinical presentation, imaging characteristics, treatment methods, and risk factors remain unclear. In this study, we discuss and analyze the above-mentioned features of SPV DAVF.We retrospectively reviewed 30 patients with SPV DAVF, with a 1-year follow-up rate of 96.67% (29/30). The neurological function of the patients was assessed using the modified Aminoff-Logue scale (mALS) and the modified Rankin Scale score (mRS). The risk factors before and after treatment were established using univariate and multivariate logistic regression analyses. Additionally, treatments involving three distinct SPV DAVF drainage patterns were presented.Of the 30 patients, 24 were male (80.0%). Besides, the angiography images were re-examined 12 months after surgery. Univariate analyses indicated that the extent of edema (OR 1.889, 95% Cl 1.132-3.154) and the number of draining veins (≤ 2) (OR 10.833, 95% Cl 1.961-59.834) were risk factors for pretreatment mRS ≥ 3. However, multivariate analyses revealed no statistically significant differences (P = 0.051, P = 0.055). Following the multivariate analyses, steroid pulse (OR 12.153 95% Cl 1.080-136.772) was found to be the only significant risk factor for post-treatment ΔmRS ≥ 2.DAVF with SPV drainage is an uncommon type of intracranial vascular malformation. Most lesions involve the brain stem or high cervical spinal cord, thereby posing a higher risk of disability or death. Moreover, neuronal damage from persistent venous hypertension is permanent. Therefore, precise diagnosis and timely treatment are key to a good patient prognosis.Copyright © 2022 Elsevier Inc. All rights reserved.