Summary: Following technological advances in endovascular therapy, this approach is preferred over surgery as the mainstay of treatment for dural arteriovenous fistula (dAVF). However, surgery remains important, and its role should be re-evaluated. In this retrospective study, we investigated the outcomes of surgical treatment for dAVF, focusing on the pitfalls of this approach in 101 patients who underwent surgery for dAVF. We analyzed the characteristics of lesions treated surgically, as well as treatment outcomes including the morbidity, AV shunt occlusion, and recurrence rates. The results included 20 patients who underwent only surgical treatment. The surgical morbidity rate was 5%. All AV shunts were extirpated at radical procedures; however, recurrence occurred in one patient. In conclusion, surgery serves as definitive treatment for specific types of dAVF. Careful decision-making regarding an endovascular vs. an open surgical approach is important, together with preparedness to manage the associated challenges, as observed in this case series.