Bilateral thalamic edema is extensive and includes vascular, metabolic/toxic, neoplastic, and infectious causes. but dural arteriovenous fistulas (DAVFs) are a relatively rare with an incidence rate of about 8% and widely underrecognized cause of thalamic edema.Tentorial dural arteriovenous fistulae (TDAVF) are a relatively rare subtype and angiographic retrograde drainage through cortical or subarachnoid veins, deep drainage through the vein of Galen associated with hemorrhage, with 97% causing hemorrhage and having the most aggressive neurological behavior. The Venous sinus thrombosis or high flow arteriovenous malformations or a combination of both may result from venous hypertension, which secondary to bilateral thalamic dysfunction. The structure of the feeding arteries is extensive, involving meningeal arteries from the internal carotid artery (ICA) and vertebral artery that are difficult to cannulate and there is a risk of serious complications from embolic material retrograde flow than ECA feeders. Transvenous navigation to deeper locations around the tentorium is difficult. More importantly, tentorial DAVF often drain exclusively to subarachnoid veins rather than to their associated sinus (Borden Type III), which prevents transvenous access. Due to middle meningeal artery is the most important dural feeder, which supply more than two-thirds of the cranial dura. In this article, We present a unique case of symptomatic bilateral thalamic edema caused by both a tentorial galenic dural arteriovenous fistula and straight sinus thrombosis of the deep venous system and we detail our treatment approach and experience.