We present the clinical case of a 50-year-old woman, a tightrope walker by profession, with no personal history of interest, who progressively developed, over a period of about 10 years, a malformation of the scalp consisting of a left frontal irregular mass, approximately 12x11 cm in its main axes, pulsatile, with significant development of the vascular network of the cranial calotte, in charge of the superficial temporal arteries and their venous return branches. In the anamnesis, the patient recalls a traumatic history 12 years ago, with frontal contusion, after which she suffered a large bifrontal subgaleal haematoma, which resolved conservatively over the course of approximately two months. Apart from this incident, he reported no other symptoms and the physical and neurological examination was normal. In view of the suspicion of a traumatic arteriovenous malformation, imaging tests were requested. Cerebral MRI showed no significant alterations and cerebral angiography of the internal and external carotid artery territories showed a left frontal epicranial vascular nidus, with extracranial vascular contributions from both superficial temporal arteries, and contributions from the intracranial circulation by transosseous meningeal branches coming from the ethmoidal arteries and dependent in turn on the two ophthalmic arteries, left and right. Neither the embolisation of the intracranial branches due to the high risk of amaurosis of one or both eyes, nor of the extracranial branches was carried out, as it was considered possible to resect the AVM by surgical intervention alone. A bicoronal incision was made behind the nidus, bilaterally accessing the nourishing branches of the AVM, in order to first ligate and section them and thus reduce the blood supply to the lesion and make resection of the lesion possible with controlled bleeding. The nidus was located outside the pericranium and under the subcutaneous cellular tissue, and showed irrigation through the calotte from the intracranial branches as evidenced by the previous angiography. Radiofrequency coagulation, both mono and bipolar, and bone wax were used to control haemorrhage. All subcutaneous blood vessels were resected, and hair follicles were evident only in a few isolated areas. During surgery it was necessary to transfuse with two red blood cell concentrates, and a blood salvager (ORTHOPAT HAEMONETICS) was used to better control blood loss. The scalp was sutured in the usual way by planes and the skin was sutured with agrafes. Postoperatively, there were no neurological complications and the wound healed adequately, with no areas of necrosis or alopecia developing. The cosmetic result was excellent. After one year she has shown no recurrence.