E-mail: moc. Abstract Arteriovenous malformation AVM of the scalp is an uncommon entity. Its management is difficult because of its high shunt flow, complex vascular anatomy, and possible cosmetic complications. The etiology of scalp AVMs that is, cirsoid aneurysm may be spontaneous or traumatic.
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E-mail: moc. Abstract Arteriovenous malformation AVM of the scalp is an uncommon entity. Its management is difficult because of its high shunt flow, complex vascular anatomy, and possible cosmetic complications. The etiology of scalp AVMs that is, cirsoid aneurysm may be spontaneous or traumatic. Clinical symptoms frequently include pulsatile mass, headache, local pain, tinnitus; and less frequently, hemorrhage and necrosis.
Selective angiography is the most common diagnosis method. Surgical excision is especially effective in AVMs and the most frequently used treatment method. Here, we present one such case where staged embolization, excision, and subsequent grafting was done. Keywords: Arteriovenous malformation, scalp cirsoid aneurysm, treatment Introduction An arteriovenous malformation AVM of the scalp is an abnormal fistulous connection between the feeding arteries and draining veins, without an intervening capillary bed within the subcutaneous layer.
There was no history of trauma, loss of consciousness, headache vomiting, altered sensorium or weakness of body parts. Surgical intervention was tried twice but abandoned due to heavy bleeding on both the occasions. Magnetic resonance imaging MRI [ Figure 3 ] and computed tomography CT revealed multiple dilated and tortuous vessels over the scalp in frontal and both temporal and parietal region with multiple collaterals.
Right transverse, sigmoid and the jugular bulb were asymmetrically prominent. Angiography revealed cirsoid aneurysm with feeders from external superficial temporal, retroauricular and occipital , internal carotid parasiting vessels from the callosomarginal arteries and the left P2 VIA left vertebral arteries. Care was taken to digitally compress the varix edges to prevent inadvertent embolic particle to enter the intracranial venous system.
Ligation of remaining feeders and excision of varix with primary suturing of the scalp defect [ Figure 6 ] was done 10 days later. Patient was started with Low molecular weight heparin and dextran to prevent propagating thrombus in the deep sinuses. Postembolization and excision, CT scan showed no evidence of intracranial propagation of thrombus. Patient was subsequently taken up for skin grafting over the defect in the scalp due to ischemic edges of the defect [ Figure 7 ].
The patient made an uneventful recovery. Postoperative angiography showed only feeders from left occipital branch supplying the scalp.
Pathophysiology[ edit ] Aneurysms form for a variety of interacting reasons. Multiple factors, including factors affecting a blood vessel wall and the blood through the vessel, contribute. The pressure of blood within the expanding aneurysm may also injure the blood vessels supplying the artery itself , further weakening the vessel wall. Without treatment, these aneurysms will ultimately progress and rupture. A mycotic aneurysm is an aneurysm that results from an infectious process that involves the arterial wall. The most common locations include arteries in the abdomen, thigh, neck, and arm. A mycotic aneurysm can result in sepsis, or life-threatening bleeding if the aneurysm ruptures.
Scalp cirsoid aneurysm treatment
Cirsoid aneurysm of scalp
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