Scalp arteriovenous fistulas are abnormal connections between scalp arteries and draining veins without an intervening capillary bed. They may present as discolored nodules or pulsatile soft scalp lesions. These lesions are most commonly fed by the superficial temporal and occipital arteries with venous drainage typically occurring through extracranial veins. Intracranial venous drainage is rare. Management options include surgical excision, endovascular embolization, or direct intralesional sclerosing agent injection. Here the authors present a case of a scalp arteriovenous fistula with intracranial drainage treated with microsurgical resection by an expert interdisciplinary team, highlighting the importance of collaborative, tailored treatment strategies for optimal outcomes. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID25109
Keleş et al. (Wed,) studied this question.