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Scalp arteriovenous malformations (AVMs), commonly known as cirsoid aneurysms, are complex collections of arteries and veins that communicate directly. It has been postulated that AVMs occur both through the activation of inactive fistulous lesions and through the formation of new fistulous vascular channels through the canalization of injured vessels. Depending on their size and complexity, a variety of strategies can be used to treat them. The case of a 53-year-old male is presented who came for evaluation due to an increase in the volume of a pulsating lesion that extended from the right parietotemporal region accompanied by holocraneal headache and tinnitus. A cerebral angiotomography was performed in which a lesion composed of ectatic serpentine images, with a right extracranial location, subsequently diagnostic cerebral angiography was performed demonstrating a right frontoparietal fistulous and plexiform arteriovenous shunt fed by afferents from the right superficial temporal, posterior auricular, occipital and middle meningeal arteries, with drainage through a varicose and ectatic vein towards the external jugular vein. An endovascular embolization of the arteriovenous shunt was performed via the femoral route in two stages, achieving a "pressure cooker" construction to perform the injection of embolizing fluid and have a subtotal embolization of 93%, with this it was possible to perform a microsurgical resection with a right fronto-parietal- temporal approach resecting the deepest part, leaving the scalp with embolized vessels without resecting. To close the surgical wound, a simple flap rotation was performed to cover the skin defect derived from its resection. The patient underwent post-resection cerebral panangiography, identifying the absence of arteriovenous shunt. Depending on the extent and anatomical complexity of the malformation, clinical manifestations may vary. More than 80% of AVMs will be present at birth and the rest may develop after head trauma or surgical interventions. Appropriate therapeutic intervention is needed through selective angiography, during which endovascular embolization of the major feeding vessels can be performed before open surgical intervention. Volume-based three-dimensional computed tomography reconstructions can be used for further planning. Surgical reduction of post-embolization arterial supply will reduce intraoperative hemorrhage, facilitating total surgical resection. Removal can result in large, full-thickness skin defects that may be difficult to reconstruct without compromising functional and cosmetic results. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report. A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study. A total of 49 articles (91 patients) were included. The patients' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months. The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Background: Scalp arteriovenous malformations (AVMs), or cirsoid aneurysms of the scalp, usually present with troublesome symptoms and cosmetic disfigurement. Endovascular/percutaneous embolization has evolved as a sole treatment method or adjunct to surgical excision in the management of scalp AVMs with an excellent outcome. Purpose: To discuss minimally invasive techniques for treating scalp AVMs as well as to highlight the role of embolization before surgery. Material and Methods: This is a retrospective study of 50 patients with scalp AVM who underwent embolization (percutaneous/endovascular) during 2010–2019 at a tertiary care center. n-butyl cyanoacrylate (n-BCA) was used as an embolizing agent in all the cases and the patients were followed up at three- and six-month intervals with Doppler evaluation. Results: A total of 50 patients were included in the study. The occipital region was the most common location; 82% were Schobinger class II lesions and 18% were class III lesions. Thirteen patients had small-sized AVMs and 37 patients had large-sized AVMs. Post-embolization surgery was performed in 36 patients. Of the patients, 28 underwent percutaneous embolization, 20 underwent endovascular embolization, and two underwent both to achieve complete embolization of the lesion. The number of percutaneous procedures increased in the latter half of the study period as the safety and efficacy of the technique were established. No major complications were seen in this study. Conclusion: Embolization of scalp AVMs is a safe and effective technique and can be used in isolation for small lesions and as an adjunct procedure to surgery for large-sized lesions. [ABSTRACT FROM AUTHOR]

Cirsoid aneurysms (CAs) of the scalp are rare arteriovenous malformations presenting as nodular lesions of the scalp. Depending on the size and intracranial extension, they can vary from asymptomatic to potentially lethal from secondary hemorrhage. Being vascular clinically misdiagnosed cases may lead to a devastating outcome from any kind of diagnostic surgical intervention. Here, we report a case of a 45‐year‐old woman who presented with multiple papulonodular lesions on the scalp, diagnosed as CA. [ABSTRACT FROM AUTHOR]

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.

Cirsoid aneurysms, also known as arteriovenous malformations (AVMs), of the scalp are relatively rare lesions. They may be found incidentally or with symptoms such as an enlarging pulsatile mass, headache, or bleeding. This retrospective case series comprised 10 cases of scalp AVMs that were treated with surgical excision from January 2010 to January 2020. Diagnosis was made with simple palpation and computed tomography angiography. Scalp AVMs were categorized according to the Schobinger classification. There were 10 patients, 8 males and 2 females, with a mean age of 22.6 years (range, 10–40 years). All patients underwent ligation of the feeding artery with total excision of the AVM. There were no postoperative complications or recurrences during a mean follow-up of 21.6 months. Preoperative embolization reduces vascularity and helps in easy identification as well as complete excision of cirsoid aneurysms during surgery. However, surgical excision alone of cirsoid aneurysms also results in excellent outcomes. [ABSTRACT FROM AUTHOR]

Cirsoid aneurysms, formerly identified as arteriovenous malformations (AVMs), represent infrequent vascular anomalies primarily localized within the scalp. These anomalies are typified by the absence of interposing capillaries, giving rise to extensively vascularized, expanded conduits connecting arterial feeders and venous outflows. This report details a case of a 13-year-old male afflicted with a cirsoid aneurysm in the scalp, who presented with swelling on the left frontal region, accompanied by headache and pulsatile sensations. Definitive diagnosis was achieved through radiological and histopathological examinations. Scalp cirsoid aneurysms may either be congenital in nature or arise following traumatic incidents, with clinical manifestations typically surfacing in the third decade of life. Common clinical presentations encompass a palpable, pulsatile subcutaneous mass, throbbing headaches, tinnitus, and cosmetic concerns. Diverse therapeutic strategies, including surgical excision, endovascular embolization, and percutaneous injection of sclerosing agents, can be employed contingent upon the particular characteristics of the lesion., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gore et al.)

A case of 33 year old man diagnosed with a rare case of Cirsoid aneurysm of occipital artery was treated under general anaesthesia for surgical excision. An interdisciplinary approach of Neurosurgery and Oral and Maxillofacial team was made. Here we have discussed the clinical steps performed in the management of Cirsoid aneurysm of occipital artery. In-toto excision and thorough follow up has uneventfully lead to success in the outcome. [ABSTRACT FROM AUTHOR]

Background Scalp arteriovenous fistulas (AVFs) are a rare vascular disease usually presenting as a progressively increasing pulsating mass in the scalp. These lesions can be associated with mild to severe complications, including congestive heart failure. If ruptures, this pathology constitutes a life-threatening medical emergency because of its potential to cause severe bleeding and acute anemia. Methods We describe the case of a young woman with a ruptured Yokouchi type C scalp AVF with eyelid involvement. Results The patient presented with hypovolemic shock and acute anemia due to severe bleeding from the lesion. Emergent treatment through a combined endovascular and open surgical approach was required to stop bleeding and stabilize the patient. Conclusions Emergent and effective treatment is required to stop bleeding when a scalp AVF ruptures. A combination of endovascular embolization and microsurgical excision of the shunt is a treatment option. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Cirsoid aneurysm of the scalp is a rare arteriovenous fistula having a traumatic, congenital, iatrogenic, or idiopathic etiology. Its presentation can range from a small swelling to a large pulsatile mass with tinnitus, headache, and scalp necrosis., Observations: A 67-year-old female presented with a gradually increasing swelling on her forehead and head since childhood and no history of trauma. Examination revealed 12 × 5 cm tortuous midline swelling. Computed tomography angiography revealed a mass of tortuous vessels in the right frontoparietal region of the scalp with no bony defect or intracranial extension. Contrast-enhanced computed tomography of the head showed no intracranial pathology. The diagnosis of cirsoid aneurysm was made, and surgery was planned. A bicoronal incision was made. The feeding arteries were dissected and ligated. The nidus was carefully separated, cauterized, and excised in toto. Inadvertently, a buttonhole in the skin was created while dissecting the nidus, which was sutured. The patient developed a small area of scalp necrosis on the 10th postoperative day, which was debrided and sutured. At the 6-month follow-up, no signs of recurrence were present., Lessons: A large cirsoid aneurysm of the scalp with multiple arterial supplies can be treated successfully with surgery. Meticulous dissection and hemostasis are warranted to avoid perioperative complications.

Scalp arteriovenous malformations, also known as cirsoid aneurysms, are complex collections of directly communicating arteries and veins. As a cirsoid aneurysm grows, it can recruit a blood supply from multiple intracranial and extracranial vessels and involve both scalp and facial tissue. Depending on their size and complexity, a variety of strategies can be used to treat them. We have presented the case of a giant cirsoid aneurysm treated with endovascular embolization, resection, and reconstruction using multiple expanded scalp and facial flaps. A 15-year-old boy had presented with a pulsatile left temporal scalp mass that had slowly grown to involve most of his left scalp and extend into the ipsilateral face. At his next presentation, at 19 years old, he had recently developed episodic lateral visual field loss, photophobia, headaches, and vertigo. Catheter angiography demonstrated an extensive arteriovenous malformation supplied primarily by the left superficial temporal, posterior auricular, and occipital arteries, as well as by the ophthalmic artery, The angiogram also showed a dural arteriovenous fistula. Initially, tissue expanders were placed in the vertex, occipital, and left lower facial regions. The patient then underwent endovascular embolization, followed by resection and reconstruction of the tissue defect using multiple expanded scalp and facial flaps. The patient recovered well without neurological deficits and had complete resolution of his symptoms. Our surgical collaboration resulted in overall preservation of his hairline and facial symmetry. Large cirsoid aneurysms can require multidisciplinary treatment combining embolization, resection, and plastic surgical techniques to close the tissue defects. [ABSTRACT FROM AUTHOR]

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.

Background Arteriovenous malformations (AVMs) of the scalp are rare and infrequently encountered by the neurosurgeon. Case Description We report a unique case of a 42-year-old patient who presented with a progressive worsening of visual acuity in the right eye (lower quadrantanopia) and palpebral ptosis. Physical examination revealed a right exophthalmos and a right frontoparietal scalp soft swelling when the patient was in the supine position. Neurologic work-up showed a scalp AVM extending into the orbit and connected to an intraorbital cavernous angioma. The patient was treated with a frontotemporal craniotomy and decompression of the orbit. Conclusions In the rare case of intraorbital extension of a scalp AVM, neurologic symptoms may appear when the size of the vascular malformation increases with age. The aims of surgery should be decompression of the orbit and aesthetic preservation, rather than complete excision. A review of the literature is also provided. [ABSTRACT FROM AUTHOR]

Scalp cirsoid aneurysm is an arteriovenous fistula of the scalp that is unconnected by intracranial or cerebral vessels. Variceal dilatation of draining veins can produce cosmetic concerns, masses, local pain, palpable thrills, and audible bruits, headache, tinnitus, and 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. An updated systematic review of the last 10 years publications was performed. Also, we report an illustrative case of a young boy with posttraumatic cirsoid aneurysm and good documentation on head vascular examinations, treated by multiple routes (percutaneous embolization with coils and endovascular embolization with cyanoacrylate) with a decrease of the pulsatile mass. A plastic surgery team performed gross total resection, and the final esthetic result was extremely satisfactory. Highlights • Cirsoid aneurysm is a pathologic abnormal structure connecting the artery and vein. • It is a rare condition, with fewer than 60 cases reported in the last 10 years. • Almost every patient reported progressive, pulsatile swelling or a mass with bruits. • Treatment includes embolization, surgery, or a combination. [ABSTRACT FROM AUTHOR]

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.

Scalp cirsoid aneurysm, also known as arteriovenous fistula, is a rare condition that commonly presents with a pulsatile cutaneous mass. Angiography is the gold standard for diagnosing this rare lesion. Here, we report the case of a 21-year-old woman who presented with a 7-year subcutaneous pulsatile mass over the suboccipital region. Computed tomographic angiography and conventional angiography confirmed the diagnosis of scalp cirsoid aneurysm. No residual or recurrent fistulas were observed after treatment with only endovascular embolization. [ABSTRACT FROM AUTHOR]

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.

Introduction Scalp AVM (SAVM) is a rare condition. Although surgical excision is considered as definitive treatment for these lesions, troublesome intraoperative bleeding may pose a challenge. Embolization as an alternative modality is gaining popularity. Proximal feeding artery temporary clipping has been utilized by the authors in this series to address troublesome intraoperative bleeding. Presentation of cases The authors present their experience in the surgical management of 3 cases with SAVMs using proximal feeding artery temporary occlusion followed by total surgical excision. The clinical presentations and radiological features of these cases are discussed in the article. Intraoperative blood loss was less than 150 ml in all patients. Postoperative period was uneventful with no morbidity or mortality. Discussion Intraoperative bleeding during surgical excision of scalp AVMs can be troublesome and challenging. To combat this, the authors advocate proximal feeding artery temporary clipping prior to surgical excision of the lesion. The external carotid artery was temporarily clipped in one case and superficial temporal artery in two patients. Conclusion Although most SAVMs can be operated by traditional method of excision, use of temporary clipping of feeding arteries (like Superficial temporal artery[STA], External carotid artery[ECA]) enables total excision of giant SAVMs with minimal blood loss for a definitive cure. This novel technique obviates the need for preoperative embolization. [ABSTRACT FROM AUTHOR]

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 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. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Objective. Evaluation of management strategies for scalp arterio-venous malformation (AVM). Materials and methods. A retrospective analysis of data of 31 patients with scalp AVM was carried out at all India Institute of medical sciences New Delhi between 1997 and 2010. All the patients except one underwent digital substraction angiography. Depending upon the size of AVM, we classified them in to three groups. Group 1 (small) size up to 4.9 cm, group 2 (medium) size 5-9.9 cm and group 3 (large) size more than 10 cm. Patients in group 1 and 2 underwent direct excision. Patients in group 3 underwent pre-operative embolization followed by surgical excision. Five patients refused any treatment. Patients were analysed to look into results, complications and recurrence in follow up. Results. There were 11 patients in group 1, 12 in group 2 and 8 in group 3. There were 18 males and 13 females with mean age of 25 years ranging from 13 to 55 years. The mean duration of symptom was 7.2 years. Angiography was performed in 30 patients. Superficial temporal artery (80.6%) was the most commonly involved. 18 patients underwent direct excision, 6 underwent embolization followed by excision and 2 underwent embolization. One patient in surgery group and two patients in embolization group had recurrence. One patient expired due to complications of hypotensive shock secondary to exsanguinating haemorrhage from AVM. Conclusion. Surgical excision has excellent outcome in treatment of scalp AVM. Pre-operative embolization reduces vascularity and helps in easy identification of AVM during surgery thus achieving complete excision. The size of AVM has no correlation with the number of feeding vessels. There are high chances of recurrence in large AVM after embolization. [ABSTRACT FROM AUTHOR]

Background: Scalp arteriovenous fistulas (AVFs) are rare and potentially complex lesions that can be treated in a multimodal fashion. We present here the first successful treatment of a Stage Ib scalp AVF using a balloon-protected, retrograde transvenous embolization with the liquid embolic Onyx. Method: We describe the case of a 60-year-old man with a scalp AVF that had a fine, diffuse, serpiginous arterial supply, precluding a transarterial approach, and multiple venous drainage paths, including the external jugular vein (EJV). The lesion was successfully embolized exclusively via a femoral transvenous retrograde approach using Onyx with balloon-protection of the EJV to simultaneously prevent pulmonary embolism and enable improved retrograde casting of the fistula-outflow zone. Findings: The combined use of Onyx with proximal balloon-protection in a transvenous retrograde femoral approach is a novel method that can be used to definitively treat scalp AVFs with a defined catheter-accessible venous outflow. Conclusion: This technique may be useful when transarterial embolization, direct puncture, or surgical excision are not practical or possible. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To report results of the application of endovascular techniques in the management of scalp cirsoid aneurysms. MATERIALS AND METHODS: Four patients diagnosed with cirsoid aneurysms were submitted to treatment by endovascular approach. All the four patients included in the present series had arteriovenous malformations and were treated solely by embolization. RESULTS: Three of the patients underwent endovascular treatment by transarterial embolization and one was treated by direct puncture of the venous segment. Both clinical and cosmetic outcomes were satisfactory in all of the patients. Clinical relapse was not observed along the follow-up period. CONCLUSION: The endovascular approach is safe and effective in the management of crisoid aneurysms. Although this technique can be used as an adjuvant or complement to surgery, particularly in cases where deep afferents are involved, complete resolution can be achieved only with endovascular treatment. The choice of treatment method should be based on a range of typical characteristics of the lesion, including angioarchitecture, size and clinical presentation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study reviewed the surgical management of cirsoid aneurysms of the scalp, which are rarely encountered in the neurosurgical practice, and compares the results with embolization. 21 patients with cirsoid aneurysm underwent surgery. There were 1 female and 20 male patients. Trauma was present in four patients. Selective internal and external carotid artery angiograms and cranial magnetic resonance imaging studies were performed on all patients. All angiograms were staged according to published procedures. There were 15 (71.4%) Stage 1a, 4 (19.1%) Stage 1b, and 2 (9.5%) Stage 3 patients.Total excision of the lesion was achieved in 19 patients (90.5%). We operated on only one patient for a second time, because of a residual lesion, and we resected the lesion totally. Only two patients developed necrosis of the scalp (button hole). Both scalp necroses were on the frontal area. Other patients all had good cosmetic results. Surgical resection of cirsoid aneurysms seems to be the most effective treatment with good results. There may be a tendency for the occurrence of necrosis on the frontal area. Staging of the scalp aneurysms has no effect on surgical outcome. [ABSTRACT FROM AUTHOR]

Aims: We discuss our experience with the surgical management of scalp vascular malformation and review the literature on the subject. Settings and Design: A prospective case-control study of eight patients with scalp vascular malformations admitted to our hospital between 1997 and 2002. Methods and Materials: All the patients were investigated with selective internal and external carotid angiography. Depending upon the origin of feeding arteries, the scalp vascular malformations were classified into two categories: Group I: the primary scalp arteriovenous malformations and Group II: secondary venous dilatations. Six patients belonged to Group I and two patients were in Group II. Results: Five patients belonging to Group I underwent successful excision of the arteriovenous malformation. There was no recurrence in this group. Of the two patients in Group II, one patient who had scalp vascular dilatation simulating a primary scalp vascular malformation underwent excision of the lesion. This patient developed severe postoperative brain edema and died. Conclusions: Primary scalp vascular malformation can be excised safely. However, excision of secondary scalp venous dilatation without treatment of the intracranial component can be dangerous. [ABSTRACT FROM AUTHOR]

A case of Dieulafoy’s vascular malformation of the jejunum treated by laparoscopic surgery is described. The patient was a 31-year-old-woman who had complained of melena and had severe anemia needing blood transfusion. Angiography revealed microaneurysms and hypervascularity of the jejunum in the area between the first and second jejunal arterial fields. Laparoscopic partial resection of the jejunum was performed. The resected specimen was histologically diagnosed as Dieulafoy’s vascular malformation. Since the operation, the patient has been free of melena and anemia. Small-intestinal Dieulafoy’s vascular malformation is rare, as only 41 cases have been reported during the past three decades. Almost two-thirds of the patients were under 40 years old. Most of the patients complained of melena. The lesion was preoperatively identified in 14 of the 41 patients, while angiography was useful to define the lesion. Thirty-six of 37 patients for whom treatment methods were reported were surgically treated. While there are various treatment methods for intestinal bleeding, a surgical operation is often needed. When the disease location is obvious, treatment with laparoscopic surgery can reliably produce good results, in terms of its rate of cure, minimal invasiveness, and better cosmetic effect. [ABSTRACT FROM AUTHOR]