Open surgical management of a high-flow supratentorial pediatric pial arteriovenous fistula.

Pial arteriovenous fistulas (pAVFs) in pediatric patients are a rare, usually congenital, high-flow vascular anomaly. Because of their rarity, there are no consensus treatment guidelines. Although most pAVFs can be treated endovascularly, surgical treatment has yielded higher obliteration rates. Superficial pAVF varix location and angioarchitecture difficult for endovascular flow occlusion can also make resection more favorable. Here the authors present the case of an incidentally diagnosed left posterior parietal pAVF in a 14-year-old boy, which was treated successfully with a craniotomy and fistula ligation. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID25107.