Cirsoid Aneurysm of the Scalp: A Case Report

Abstract

Cirsoid aneurysms (arteriovenous malformations [AVMs]) of the scalp are rarely encountered in neurosurgical practice. Patients with AVM of the scalp present clinically at times with headache and a small innocuous-looking subcutaneous scalp lump or a large, pulsatile mass with or without bruit, which has a propensity to massive hemorrhage. Complex vascular anatomy and interconnections, high shunt flow, and possible cosmetic complications tend to make their management difficult. We report a rare case of young man who presented with progressively enlarging swelling over left fronto-temporo-parietal and occipital region of the scalp since 8 years. Digital subtraction angiography of internal and external carotid vessels revealed high-flow, complex left parietal scalp AVM supplied by multiple tortuous feeders from left superficial temporal artery (STA), left middle meningeal artery, left occipital artery with collateral supply from right occipital artery, and right STA. Drainage into external jugular vein through multiple tortuous frontal, temporal, and occipital scalp veins with venous varix. Being high-flow shunt and because of suspected cosmetic complications, surgical excision was considered.

Keywords

arteriovenous malformation - cirsoid aneurysm - scalp

• References

• 1 Muthukumar N, Rajagopal V, Manoharan AV, Durairaj N. Surgical management of cirsoid aneurysms. Acta Neurochir (Wien) 2002; 144 (4) 349-356
• 2 Nagasaka S, Fukushima T, Goto K, Ohjimi H, Iwabuchi S, Maehara F. Treatment of scalp arteriovenous malformation. Neurosurgery 1996; 38 (4) 671-677 , discussion 677
• 3 Khodadad G. Familial cirsoid aneurysm of the scalp. J Neurol Neurosurg Psychiatry 1971; 34 (6) 664-667
• 4 Gurkanlar D, Gonul M, Solmaz I, Gonul E. Cirsoid aneurysms of the scalp. Neurosurg Rev 2006; 29 (3) 208-212
• 5 Chatterji P, Purohit GN, Soni NK. Cirsoid aneurysm of the auricle and adjoining scalp. J Laryngol Otol 1977; 91 (11) 997-1002
• 6 Barnwell SL, Halbach VV, Dowd CF, Higashida RT, Hieshima GB. Endovascular treatment of scalp arteriovenous fistulas associated with a large varix. Radiology 1989; 173 (2) 533-539
• 7 Elkin DC. Cirsoid aneurysm of the scalp: report of four cases. Ann Surg 1946; 123: 591-600
• 8 Wilkinson HA. Recurrence of vascular malformation of the scalp 18 years following excision. Case report. J Neurosurg 1971; 34 (3) 435-437