Post-Traumatic Arteriovenous Fistula of the Scalp

Successful Use of Neurovascular Plug for Embolization of Scalp Arteriovenous Fistula: A Novel Technique

PURPOSE

We report a case of a pediatric patient developing a delayed-onset scalp arteriovenous fistula (AVF) and pseudoaneurysm managed with a new technique.

TECHNIQUE

A 10-year-old boy presented to the outpatient clinic complaining of a growing pulsatile mass in the right side of the skull after head trauma 6 months ago. He had no neurological deficits. Imaging studies revealed scalp AVF with pseudoaneurysm. The arterial feeding was from the right temporal artery, while the blood was drained into the superior sagittal sinus and the facial vein. The fistula was occluded successfully by a microvascular plug (MVP). Follow-up angiography 1 year later showed that the AVF was no longer seen with complete embolization of pseudoaneurysm, total occlusion of the abnormal vessels, and the absence of MVP migration.

CONCLUSION

To the best of our knowledge, we report the first case of successfully using MVP to treat scalp AVF. The MVP is a novel technique with its unique ability to achieve rapid, safe, effective, and permanent vascular occlusion through a single device. Besides, the possibility of delayed-onset traumatic vascular injuries should be considered in a patient with head or facial trauma.

A Case of Scalp Arteriovenous Malformation Treated by Transvenous Embolization Using Onyx

Objective

We treated a case of scalp arteriovenous malformation (sAVM) by transvenous embolization using Onyx.

Case Presentation

We describe the case of a 17-year-old woman with a pulsatile mass at the right temporal area. DSA identified sAVM with the venous pouch between the right occipital artery (OA) and the right two occipital veins (OVs), which was also fed by multiple branches of the right posterior auricular artery (PAA) and superficial temporal artery (STA). The shunts were completely occluded by the reverse pressure cooker technique (RPCT), which involves navigating the balloon catheters just distal to the shunt point in the OVs approaching from the right external jugular vein (EJV) and injecting Onyx to each feeder retrogradely with balloons inflated.

Conclusion

This technique may be useful for treating sAVM with venous angioarchitecture enabling a transvenous approach.

Cirsoid aneurysm rupture of the splenic artery as a rare cause of fatal hemoperitoneum

Cirsoid aneurysms are rare arteriovenous malformations without any capillaries interposed and almost always observed in the scalp region. These types of aneurysms are so-called "cirsoid" because of their serpiginous appearance. In this report, the authors present the first case of a lethal spontaneous rupture of a cirsoid aneurysm of the splenic artery, which could be diagnosed only by post-mortem histologic examination. The victim was a 70-year-old man who was suddenly found dead in bed while he was hospitalized and waiting for a scheduled cardiac surgery. A forensic autopsy was ordered due to the suspicion that the man's death could have been related to medical malpractice. An accurate autopsy and a complete forensic histologic examination could clarify the cause of death, which was identified in the spontaneous rupture of a cirsoid aneurysm of the splenic artery. The case is intended to be used as source data for similar forensic cases, where the cause of a massive hemoperitoneum is difficult to be identified.

Contemporary management of scalp cirsoid aneurysm: A dual-trained neurosurgeon's perspective

OBJECTIVE

Scalp cirsoid aneurysms are subcutaneous arteriovenous fistulae fed by branches of the external carotid artery. They present with progressive scalp swelling and cosmetic deformities in addition to neuro-vascular symptoms. We evaluate the treatment and outcome of this rare vascular lesion with surgery and adjunctive endovascular embolisation performed by a dual-trained neurosurgeon.

METHODS

A retrospective analysis of 6 cases operated over a 16 year-period was performed which comprised of clinical data, radiology including angiography and pre-operative embolisation, surgical approaches, outcomes and complications.

RESULTS

6 patients with ages ranging between 26 and 51 years were operated in the study period. All the patients underwent surgical excision of the lesion, of which 2 had undergone pre-operative embolisation of the feeders. There was no recurrence in the follow-up period (Mean 4.7 years) following total excision of the lesions. One patient had post-operative wound dehiscence and another had migration of embolic material to lungs.

CONCLUSION

Surgery is the predominant treatment method for scalp cirsoid aneurysms. Various adjunctive endovascular procedures can be performed pre-operatively to minimise operative blood loss.Though lower recurrence is seen with surgery for the scalp AV fistula, embolisation performed in select cases can achieve curative results with appropriate techniques.

Symptomatic scalp fistula present in a 14-month-old toddler

This case report covers the resection of a pulsatile scalp fistula, in a 14-month-old toddler. We discuss the patient diagnosis, imaging techniques used, as well as the patient's surgical intervention. We highlight the aetiology of arteriovenous fistulas, while comparing and contrasting previous case reports and their interventions, to our own specific case.

Post-traumatic arteriovenous malformation of the superficial temporal artery

An arteriovenous malformation is a rare vascular anomaly composed of a complex network of interconnected arteries and veins of the scalp. It is usually congenital, but infrequently occurs after trauma. Over the years, several terms have been used to describe these lesions, such as cirsoid/rasemose/arteriovenous aneurysm, plexiform angioma and aneurysma serpentinum, or arteriovenous fistula when a single connection exists. Head and neck malformations occur in 0.1% of the population. Involvement of the superficial temporal artery is rare, occurring in about 0.5% to 2.0% of cases. They are diagnosed by angiography and can be managed by endovascular or open resection. The case of a 23-year-old man who presented with a pulsatile head mass after blunt trauma 5 years prior is presented. This entity was diagnosed as an arteriovenous malformation supplied by the superficial temporal arteries. He subsequently underwent successful open exploration and resection. The information is presented with the patient's consent.

Intravascular embolization versus surgical resection for patients with scalp arteriovenous fistula

Background

Scalp arteriovenous fistula (sAVF) is a rare vascular disease; so far, the standard guidelines for the treatment of sAVF are still unclear. Since its complex vascular anatomical structure, surgical management of sAVF remains an enormous challenge.

Methods

Between March 2016 and October 2017, three patients with sAVF admitted to the First Affiliated Hospital of Chongqing Medical University were reviewed, and clinical characteristics, imaging features, and surgical outcomes were analyzed.

Results

Three consecutive patients with sAVF were admitted to our hospital during the study period. Two patients received intravascular embolization and one patient received surgical resection. No procedure-related complications occurred after successfully treatment. During the long-term follow-up period, three patients recovered well and had no recurrence of lesion.

Conclusions

Either intravascular embolization or surgical resection is an effective therapy method for sAVF. Careful identification of angioarchitecture features contributes to successful treatment for the complex sAVF; therefore, it is recommended that neurosurgeons make the best treatment plan based on the location and number of the fistulas, feeding the artery, and draining the vein.

Identity of growing pulsatile mass lesion of the scalp after blunt head injury: Case reports and literature review

A growing pulsatile lump of the scalp rarely occurs after blunt head injury. In this condition, the lump may be a delayed-onset traumatic vascular scalp injury such as a pseudoaneurysm or an arteriovenous fistula (AVF). We describe two cases of delayed-onset traumatic vascular scalp injuries: one involved a pseudoaneurysm of the superficial temporal artery, and the other, an AVF fed by the occipital artery. We reviewed reported cases of delayed-onset traumatic vascular scalp injury and discuss the features, diagnosis and treatment. When a growing lump of the scalp is encountered, ultrasonography may be useful in searching for vascular injuries.

Acquired Spinal Arteriovenous Fistula Presenting as Brown-Séquard Syndrome and Endovascular Treatment Outcome

BACKGROUND

Brown-Séquard syndrome is typically caused by penetrating trauma to the cervical spinal cord; however, other compressive and vascular occlusive etiologies have been previously described. It is extremely uncommon to have a delayed presentation as an extramedullary compressive lesion from the venous varix of an acquired spinal arteriovenous fistula.

CASE DESCRIPTION

We present a case of a patient in the fifth decade of life, with a remote history of gunshot wound to the left thorax with progressive left-sided weakness and contralateral pain and temperature sensory loss secondary to cord compression from an acquired spinal arteriovenous fistula.

CONCLUSIONS

Subsequent treatment occurred with coil embolization with good outcome.