The venous sinus balloon protection technique is regarded as a safe and effective method for treating transverse-sigmoid sinus (TSS) dural arteriovenous fistulas (DAVFs). However, large cohort studies on this technology are still lacking. This study aims to present a large single-center experience on the safety and efficacy of venous sinus balloon protection in the treatment of TSS DAVFs.We conducted a retrospective review of our database, identifying all patients with low-and intermediate-grade TSS-DAVFs who underwent transarterial embolization (TAE) between 2002 and 2020. The patients were categorized into two groups: the Venous Sinus Balloon Protection (VSBP) group and the Non-Venous Sinus Balloon Protection (NVSBP) group, based on the use of the venous sinus balloon protection technique. The safety and efficacy of the venous sinus balloon protection technique were subsequently analyzed.The study included 161 patients with low-and intermediate-grade TSS-DAVFs who received TAE, comprising 72 individuals in the VSBP group and 89 in the NVSBP group. The objective of the study was to evaluate the safety and efficacy of sinus balloon protection by comparing clinical and angiographic outcomes, as well as complication rates, between the two groups. Favorable clinical outcomes were similar between the two groups (VSBP 93.1% vs. NVSBP 96.6%, P=0.501), with no statistically significant difference in the incidence of the rate of complications (VSBP 1.4% vs. NVSBP 2.2%, P=1.000). However, the rate of complete occlusion was significantly higher in the VSBP group compared to the NVSBP group (87.5% vs. 69.7%, P=0.007).The sinus balloon protection technique demonstrates excellent safety and effectiveness, significantly improving the complete occlusion rate of low-and intermediate-grade TSS-DAVFs in the near term, without increasing the incidence of complications. In the future, larger prospective cohorts are needed to further elucidate and confirm the safety and effectiveness of the sinus balloon protection technique for all dural arteriovenous fistulas.Dural arteriovenous fistula; Transverse-sigmoid sinus; Transarterial embolization; Venous sinus balloon protection.© 2025 by American Journal of Neuroradiology.