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

Alfawaz, Abdullah; AlShatti, Hamad J.; Safar, Ali H.

doi:10.1016/j.amsu.2022.103479

Cited by 5 publications

(1 citation statement)

References 17 publications

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“…The complications described were pain and thrombosis at the site of injection, the need for subsequent excision for cosmetic reasons in two cases, and spilling of glue material into the external jugular vein in one patient with a large occipital scalp lesion. 17 In a series of six cases by AlFawaz et al., 18 one underwent preoperative intraarterial embolization. However, it did not abolish the pulsation completely and was resected surgically.…”

Section: Discussionmentioning

confidence: 99%

A large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case

Pahari,

Bhandari,

Bhattarai

et al. 2024

Journal of Neurosurgery: Case Lessons

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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.

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Section: Discussionmentioning

confidence: 99%

A large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case

Pahari,

Bhandari,

Bhattarai

et al. 2024

Journal of Neurosurgery: Case Lessons

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Combined Preoperative Endovascular Embolization and Surgical Excision for Scalp Arteriovenous Malformations: A Systematic Review and Case Illustration

Alghamdi,

Alboqami,

Ateeq

et al. 2024

World Neurosurgery

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Manejo multimodal de aneurisma cirsoideo. Reporte de un caso y revisión de la literatura

Wong del Pino,

Vázquez Nieves

2023

Rev Fac Med

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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. Keywords: Cirsoid aneurysm; multimodal management; treatment; endovascular; giant

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

Cited by 5 publications

References 17 publications

A large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case

A large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case

Combined Preoperative Endovascular Embolization and Surgical Excision for Scalp Arteriovenous Malformations: A Systematic Review and Case Illustration

Manejo multimodal de aneurisma cirsoideo. Reporte de un caso y revisión de la literatura

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