Results of surgical excision of cirsoid aneurysm of the scalp without preoperative interventions

Abstract

Context:Cirsoid aneurysms of scalp are rare lesions which are mainly treated by surgical excision. Endovascular embolization was described either alone or prior to surgery in order to minimize the risk of bleeding. However, the endovascular therapy also carries the risk of scalp necrosis, escape of embolization material to circulation, and recurrence of the lesion.Aim:To evaluate the results of well-planned classic surgical excision of cirsoid aneurysm.Study Design:This is a retrospective case series study.Materials and Methods:This is a retrospective case series study on nine patients with cirsoid aneurysms who were treated with surgical excision. Preoperative Planning for location, size, feeding arteries, and venous drainage of the lesions were done by plain and contrast enhanced CT, MRI, MR angiogram, and selective internal and external carotid angiograms. Complete surgical excision for the lesions was done. Postoperative evaluation of excision was done by cranial magnetic resonance angiography in all the patients. The mean follow up period was 34.1 (±7.62 STD) months.Results:The lesion was located in the occipital region in three (33.3%) cases, frontal region in two (22.2%) cases, temproparietal region in two (22.2%) cases, parietal region in one case (11.1%), and vertex in one case (11.1%). The superficial temporal artery was involved in seven (77.8%) cases, the occipital artery was involved in six (66.7%) cases, the posterior auricular artery was involved in five (55.6%) cases, the supraorbital artery was involved in two (22.2%) cases and the middle meningeal artery was involved in two (22.2%) cases. Total excision of the lesion was achieved in eight patients and en bloc resection and primary closure was done in one patient. Postoperative magnetic resonance angiogram showed no residual lesion in all patients. No postoperative complication related to the surgery had occurred. No recurrence had occurred during the follow-up period (mean 34.1 ± 7.62 STD months).Conclusion:Well-planned surgery of cirsoid aneurysm of the scalp without preoperative interventions could achieve complete excision of the lesion without any residual masses or recurrence and with a low incidence of complications.

Congenital Arteriovenous Malformation of the Scalp Involving the Orbit

“…Endovascular transarterial or transvenous embolization has been also performed with good results, as well as intralesional injection of sclerosing agents, with complete obliteration of the lesion in selected cases. 19 However, these techniques also carry the risk of complications such as skin necrosis, permanent patchy hair loss, pain, skin tenderness, and leakage of embolization material into the systemic circulation. 19 Moreover, embolization alone can be unsuccessful in $ 10% of cases.…”

“…19 However, these techniques also carry the risk of complications such as skin necrosis, permanent patchy hair loss, pain, skin tenderness, and leakage of embolization material into the systemic circulation. 19 Moreover, embolization alone can be unsuccessful in $ 10% of cases. 35 The combination of preoperative embolization and excision of the scalp AVM has a risk of skin necrosis of $ 8%.…”

Surgical resection of a complex multiple scalp avf without preoperative embolization: a case report

“…However it has been proven to be an exact and effective treatment with obvious improvement of deformity, low incidence of complications and recurrence if neurosurgeons make a meticulous plan (11). In view of this, we chose direct resection without preoperative embolization.…”

“…Once the STA is injured, an abnormal communication between arteries and veins would appear. This lesion would receive more blood volume from the abundant collaterals in the scalp, resulting in a progressive venous dilation (11). Eventually, the remarkable tortuous subcutaneous vessels can create a severe scalp and facial cosmetic deformity.…”

Intravascular embolization versus surgical resection for patients with scalp arteriovenous fistula

“…Scalp arteriovenous fistula (sAVF) is defined as an abnormal connection without a capillary vessel between the high-flow feeding artery and the low-flow draining veins of the scalp [1][2][3][4][5][6]. The etiology of sAVF may be congenitally caused or posteriori acquired and, in most patients, caused by a variety of head trauma which showed pulsatile scalp mass with vascular murmur [3,4,[7][8][9][10]. Cerebral angiography is the diagnostic gold standard and can show location and number of the fistulas, expanded feeding arteries, as well as obviously tortuous draining vein.…”