Combined Treatment of High-Flow Scalp Arteriovenous Malformations

Abstract

Introduction: Appropriate treatment of scalp arteriovenous malformations (SAVMs) remains largely unclear given the rarity of reported cases. This single-institution case series presents consecutive patients with extracranial SAVMs and longterm follow up.The primary aim of this study was to review treatment decisions, evaluate clinical outcomes, and compare our experience to available literature in order to better understand SAVMs and improve future outcomes. Materials and Methods: A retrospective review of consecutive patients with extracranial SAVMs between January 2015 and December 2019 was performed. Treatment factors of interest included embolization method, embolic agents, and decision to proceed with surgical resection. Relevant clinical outcomes included recurrence rates, cure rates, and complications. Results: Seven patients were included in the present series. Satisfactory outcomes were ultimately achieved for all 7 patients using embolization with or without combined surgical resection. Embolizations performed in combination with resection were curative in 4 of 4 cases (100%). Embolizations performed without resection were curative in 0 of 4 cases (0%), satisfactory in 2 of 4 cases (50%), and unsatisfactory in 2 of 4 cases (50%). Discussion: All SAVM patients in this series were treated satisfactorily using embolization with or without operative resection. This study strongly suggests that embolization combined with surgical resection during the same admission yields the best treatment outcomes for SAVMs, specifically demonstrating lower rates of recurrence and embolization-related complications. Decisions on whether or not to proceed with resection should be made by the interventional radiologist, the plastic surgeon, and the patient together.

Case report: Endovascular treatment of two scalp arteriovenous malformation cases via direct percutaneous catheterization: A case series

“…Surgery used to be the first choice in the past years ( 12 ). However, endovascular embolization and surgery combined with embolization have been used more frequently with the development of endovascular technologies and a new type of liquid embolic agent ( 13 ). Some other treatments have also been reported, like simple fistular ligation and sclerotherapy with ethanol, which is suitable for small lesions with low blood volume and bleeding probability ( 14 ).…”

Surgical management of scalp cirsoid aneurysms: Kuwait experience. (case series)

“…Another treatment option is endovascular embolization combined with surgical excision. Embolization as a neoadjuvant therapy before surgical excision reduced vascularity and allows accurate demarcation of the feeding artery with very satisfying outcomes [ [5] , [15] , [16] ]. [[, 15 ] [[, 16 ].…”