Modern endovascular and aesthetic surgery techniques to treat arteriovenous malformations of the scalp: case illustration.
BACKGROUND
Arteriovenous malformations of the scalp consist of abnormally connecting arterial feeding vessels and draining veins, devoid of a normal capillary bed within the subcutaneous fatty layer of the scalp. We present a case of a left temporal scalp AVM treated for aesthetic and pain-related concerns. A multidisciplinary approach combining endovascular AVM embolization and AVM excision with local flap reconstruction was chosen.


METHODS
The patient presented with a progressive painful pulsatile mass in the left temporal region. On examination, there was no evidence of any facial nerve compromise or any other neurologic deficits. Computed tomographic angiography revealed a 6-mm lesion located totally within the scalp and not associated with bone or periosteum. A recommendation was made to proceed with preoperative embolization to facilitate surgical resection. The AVM was occluded endovascularly using multiple detachable platinum coils, and the patient was neurologically intact. The following day, the patient was taken to the operating room. By that time, the mass was minimally pulsatile. The AVM was resected en bloc, and a 3-layered intermediate closure of the 5.5-cm defect was then performed. The procedure was well tolerated, and the patient had an uneventful postoperative course.


CONCLUSIONS
Scalp AVMs are interesting lesions with heterogeneous anatomical features. Treatment can be optimized in a multidisciplinary environment, using a prescribed treatment algorithm to minimize the size of soft/hard tissue defect and enhance cosmesis. Careful selection of therapeutic modalities based on AVM anatomy and aesthetic concerns can lead to safe and durable results with high patient satisfaction rates.
Hage
Ziad A
ZA
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Few
Julius W
JW
Surdell
Daniel L
DL
Adel
Joseph G
JG
Batjer
H Hunt
HH
Bendok
Bernard R
BR
D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D019736:Prostheses and Implants / Q000592:standards; D019651:Plastic Surgery Procedures / Q000379:methods; D012535:Scalp / Q000002:abnormalities* / Q000098:blood supply / Q000601:surgery*; D013524:Surgical Flaps; D013699:Temporal Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D014680:Veins / Q000002:abnormalities / Q000601:surgery