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Background: Scalp arteriovenous fistula (SAVF) is relatively rare; due to its rarity, there is currently no established consensus on the treatment strategies of SAVF. Case description: A 30-year-old male presented with a pulsating mass on his right forehead. He underwent left selective amygdalohippocampectomy for left temporal lobe epilepsy 18 years prior. Cerebral angiography showed three fistula points that were fed by the bilateral superficial temporal arteries (STA) and an expanding drainage vein. We diagnosed the patient with SAVF. Because the fistula gathered in the midline of the forehead, we planned the treatment with surgical treatment alone. First, the proximal side of the right STA, the main feeder to the fistula, was released and clamped. The fistulas made up of the three shunt points of the STAs on both sides were then detected under a microscope. Then, each of the three feeders from the STAs on both sides was clamped. Three feeding arteries and drainage veins were coagulated, and the fistula was removed. Finally, the patient was discharged without complications, including scalp necrosis, infection, and recurrence of the pulsating mass. Conclusions: In our case, SAVF may have occurred after craniotomy or frequent minor head trauma. In direct surgery of SAVF, reliable identification and exposure of the feeder and fistula under a microscope without bleeding are the key. Direct surgery with a small skin incision is possible to cure SAVF completely, especially in cases where a fistula is present.