The mode of treatment of a cirsoid aneurysm of the scalp depends mainly on its size; three methods of treatment, with case reports illustrating these, are described.Small Cirsoid Aneurysm A small cirsoid aneurysm which is localized to a small area, and especially if the skin is thin and ulcerated, is treated most expeditiously by complete excision with the overlying scalp, after carefully ligating the vessels supplying it. The defect is then closed by rotating a local flap in order to spread the tension over the whole suture line. Three years previously the swelling had started to increase in size and 'the veins oii the right side of her forehead had become dilated. She had noticed that after exercise the swelling became larger and " throbbing " was felt over it. In May, 1949, a local surgeon ligated both superficial temporal arteries, and the swelling subsided temporarily, but within a month it had regained its previous size.On examination a moderate-sized cirsoid aneurysm was found involving about one-quarter of her scalp. Over the right anterior quadrant of her hairy scalp and the right side of her forehead there were greatly dilated tortuous, hard, and pulsatile veins. A thrill could be felt over them and a " bruit de diable " was present.Operation.-On September 13, 1949, the right external carotid artery was first ligated and a large U flap was then made over the aneurysm. The medial limb of the flap started in the midline just above the base of the nose and extended vertically upwards into the hairline, curving outwards to the right, crossing the parietal and squamous temporal regions, and ending at a point about 1 in. (2.5 cm.) BRrrUH
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