A 60-year-old man presented with a 3-month history of persisting unilateral pulsatile tinnitus. He has no history of trauma. Otoscopic examination, audiometry, and tympanometry showed normal finding. An initial magnetic resonance imaging with angiography(MRA) demonstrated ill-defined left sigmoid and transverse sinuses margin. Such MRA findings was suggestive of a dural arteriovenous fistula, and a catheter angiogram was obtained revealing abnormal vasculature along the left transverse sinus and early filling of the left sigmoid sinus confirming the diagnosis of arteriovenous fistula. Although endovascular embolization may be a good treatment option, we decided to wait until the fistula could be occluded spontaneously. We herein report a case of pulsatile tinnitus from dural arteriovenous fistula of multiple branches of posterior and middle meningeal artery, basal tentorial artery to transverse-sigmoid venous sinus.