Pterional craniotomy for occlusion of a basal temporal arteriovenous fistula.

Atypical arteriovenous fistulas (AVFs) lack the parenchymal nidus observed in arteriovenous malformations (AVMs) and are not dural-based lesions supplied by meningeal arteries, unlike true dural AVFs. Atypical AVFs are parenchymally based with a nondural arterial supply. This video presents a man in his 50s with a remote carotid takedown for flow reduction of a described temporal AVM. Imaging showed a basal temporal AVF supplied by middle cerebral artery branches, coalescence of arterial feeders onto a large venous varix, and no intervening nidus. Dearterialization of the venous varix eliminated the shunting lesion. Atypical AVFs are often misdiagnosed but can be cured with microsurgical interruption. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2587.