Endovascular treatment of scalp cirsoid aneurysms.
BACKGROUND
Scalp is the most common site of soft tissue arteriovenous fistulae and surgical excision has been the primary mode of treatment. Endovascular treatment has evolved as an alternative to the surgery.


OBJECTIVE
To evaluate the effectiveness of percutaneous direct-puncture embolization of cirsoid aneurysms.


METHODS
From January 1995 to December 2004, 15 patients underwent percutaneous direct-puncture embolization of cirsoid aneurysms. Plain X-ray, computerized tomography scan and complete selective cerebral angiogram were done in all. Seven patients had forehead lesions, four had temporal and the remaining four patients had occipital region cirsoid aneurysms. Lesions were punctured with 21-gauge needle and embolized with 20-50% cyanoacrylate-lipiodol mixture. Circumferential compression was applied during injection.


RESULTS
Post-embolization angiogram showed complete obliteration in 11 patients. The remaining four patients required adjunctive transarterial embolization with polyvinyl alcohol particles for complete lesion devascularization. Two patients had post procedure surgery for removal of disfiguring and hard glue cast. There were no major procedure-related complications. No patients had any recurrence in the follow-up.


CONCLUSIONS
Percutaneous direct puncture embolization of cirsoid aneurysms is a safe and effective procedure. It can be effectively used as an alternative to surgery. Sometimes adjunctive transarterial embolization is also required to deal with deeper feeders.
Gupta
A K
AK
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India. gupta@sctimst.ac.in
Purkayastha
S
S
Bodhey
N K
NK
Kapilamoorthy
T R
TR
Krishnamoorthy
T
T
Kesavadas
C
C
Thomas
B
B
D000293:Adolescent; D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002648:Child; D004659:Enbucrilate / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D012535:Scalp / Q000098:blood supply*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
D004659:Enbucrilate