Arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) region with spinal arterial feeders are rare. There are few reports on such diseases. This study retrospectively reviewed 20 consecutive cases with CCJ AVFs with spinal arterial feeders from our neurosurgical center, which can enrich the experience of diagnosis and treatment of such arteriovenous fistulas.To further explain the clinical manifestations, angiographic characteristics, and treatment strategies of CCJ AVFs with spinal arterial feeders and share the treatment experience of our neurosurgical center.A total of 113 patients with CCJ AVFs treated at our institution between January 2013 and December 2020 were enrolled. After analyzing their imaging data, 20 patients with CCJ AVFs with spinal arterial feeders were included. Clinical presentation, angiographic characteristics, intraoperative findings, and treatment outcomes were analyzed.The median age was 52 years (IQR 45-58 years). Twenty-four fistulas were included in this study and were classified based on angiographic characteristics: dural AVF (1 [4.2%] of 24), radicular AVF (15 [62.5%] of 24), epidural AVF (2 [8.3%] of 24), and perimedullary AVF (6 [25.0%] of 24). Subarachnoid hemorrhage occurred in 19 cases (95.0%) and was the main clinical manifestation. Thirteen patients (65.0%) were treated with microsurgery only, 6 (30.0%) with embolization and microsurgery, and 1 (5.0%) with interventional electrocoagulation. Nineteen patients (95.0%) had favorable outcomes.Subarachnoid hemorrhage was the most common presentation of CCJ AVFs with spinal arterial feeders. Different treatment strategies should be selected based on different angioarchitecture.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.