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Scalp cirsoid aneurysm is an arteriovenous fistula of the scalp that is usually unconnected by intracranial or cerebral vessels. Variceal dilatation of draining veins can produce cosmetic concerns, masses, local pain, palpable thrills, audible bruits, headache, tinnitus, and torrential hemorrhage. Its etiopathogenesis is not well understood. Treatment includes surgery (fistula repair by simple surgical ligation until gross total resection), embolization (whether percutaneous or endovascular), or a combination of the two. Here is a case report of a 40-year-old male patient who had right superficial temporal artery cirsoid aneurysm who underwent surgical ligation with complete excision of the lesion.

Cirsoid aneurysm (CA) is a rare arteriovenous fistula of the scalp. There exists scant literature on the incidence and approach to CA in children. We describe a case of CA in a 7-year-old boy which was diagnosed by angiography and managed with angiographic embolization followed by surgical excision.

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.

Background: Arteriovenous malformation of the scalp (sAVM) is a rare pathology that accounts for 8% of all cranial arteriovenous malformations. It is believed to be congenital; however, few reported were secondary to trauma. They are managed either via surgical resection, endovascular embolization, or combined approach. Cases with bilateral dual extracranial feeders are yet significantly scarce incidents among this rare pathology. We report a case of sAVM with dual bilateral feeders and review the literature. Case presentation: We report a case of a 24-year-old male who presented with a spontaneous para-midline enlarging mass over five years associated with headache. Imaging, including angiography, showed a subcutaneous vascular lesion measuring 2.4x4.2 cm supplied by bilateral superficial temporal arteries and occipital arteries. The patient underwent endovascular subtotal embolization with subsequent surgical excision with excellent recovery. Conclusion: The rare occurrence of sAVMs requires a high index of suspicion and angiographic images to assess blood supply for preoperative embolization. A combined management approach is associated with good outcome and decrease the risk of recurrence.

Scalp arteriovenous malformation (SAVM) as a rare lesion may be a complication of head injury. A case and its management are presented in this article and literature is reviewed. A 27-year-old man came to us with a slowly growing pulsatile mass in his right retroauricular and parietal region of the scalp. On examination, there was a compressible mass with loud bruit. Paraclinical studies revealed a large, tortuous tuft of vessels with two different feeders. Intracranial vessels were 3 normal. The lesion excised totally by direct surgical intervention after ligation of its feeders. The patient recovered and discharged without any abnormal findings. Increased number of reports of SAVM in the past decade may be due to improved diagnostic facilities; however, the high incidence of trauma and even its increasing pattern in developing countries may be another important factor.

Abstract Cirsoid aneurysms (arteriovenous malformations [AVMs]) of the scalp are rarely encountered in neurosurgical practice. Patients with AVM of the scalp present clinically at times with headache and a small innocuous-looking subcutaneous scalp lump or a large, pulsatile mass with or without bruit, which has a propensity to massive hemorrhage. Complex vascular anatomy and interconnections, high shunt flow, and possible cosmetic complications tend to make their management difficult. We report a rare case of young man who presented with progressively enlarging swelling over left fronto-temporo-parietal and occipital region of the scalp since 8 years. Digital subtraction angiography of internal and external carotid vessels revealed high-flow, complex left parietal scalp AVM supplied by multiple tortuous feeders from left superficial temporal artery (STA), left middle meningeal artery, left occipital artery with collateral supply from right occipital artery, and right STA. Drainage into external jugular vein through multiple tortuous frontal, temporal, and occipital scalp veins with venous varix. Being high-flow shunt and because of suspected cosmetic complications, surgical excision was considered.

Cirsoid aneurysm of scalp is a rare arteriovenous malformation (AVM) of external carotid branches and scalp veins. This malformation of scalp is also synonymously called as plexiform angioma, aneurysma racesomsum, and aneurysm cirsoide, aneurysma serpentinum. This AVM can be congenital or acquired; a congenital form will be present at birth, however, becomes overt only after puberty. Superficial temporal artery is the feeder in approximately 70-80% of the cases, followed by occipital and supraorbital artery. Multidetector computed tomography angiography reconstructed images can provide excellent detail of the feeders, draining veins and their soft tissue relations. Volume rendering data sets in computer workstations we can actually perform virtual dissection layers of the lesion for operative planning. Well planned surgical excision can have least surgical recurrence rates and complications.

Aims: Scalp arterio-venous malformation (AVM) and scalp venous malformation (SVM) are rare conditions that usually need surgical treatment. Here, we have reported our experience of the surgical management of such lesions with a short review of the literature. Materials and Methods: In this prospective study, 11 patients with scalp AVM and SVM, who underwent surgical excision of lesion in our hospital from 2006 to 2012, were included. All suspected high-flow AVM were investigated with the selective internal and external carotid digital subtraction angiogram (DSA) ± computed tomography (CT) scan of brain with CT angiogram or magnetic resonance imaging (MRI) of brain with MR angiogram, and all suspected low-flow vascular malformation (VM) was investigated with MRI of brain + MR angiogram. Eight were high-flow and three were low-flow VM. Results: All lesions were successfully excised. Scalp cosmetic aspects were acceptable in all cases. There was no major post-operative complication or recurrence till last follow-up. Conclusions: With preoperative appropriate surgical planning, scalp AVM and SVM can be excised without major complication.

Cirsoid aneurysm is a small vascular proliferation characterized by small to medium-sized channels with features of arteries and veins, that present as small, blue or red asymptomatic papule. We report a case of a crisoid aneurysm on the forhead of an HIV patient that suggested a Kaposi sarcoma as a differential diagnosis.