Background: Arteriovenous malformations of the scalp
consist of abnormally connecting arterial feeding vessels and
draining veins that are devoid of a normal capillary bed within
the subcutaneous fatty layer of the scalp. The name "cirsoid"
in cirsoid aneurysm is derived from the Greek word kirsos
meaning varix or varicose vein. The en bloc excision of scalp
tissues affected by aneurysm is preferable to selective ligation
of the feeding and draining vessels. Because the management
of cirsoid aneurysm is an elective procedure, it is best to use
tissue expanders to create sufficient scalp flaps to reconstruct
the site of the excised lesion in the first stage. Preoperative
embolization greatly reduces blood loss during resection.
Aim of the Work: To present the successful management
of cirsoid aneurysms of the scalp using tissue expanders,
endovascular occlusion, and en bloc excision.
Material and Methods: Five patients who had presented
cirsoid aneurysms of the scalp (two temporoparietal, two
frontal, and one occipital) were managed successfully using
three stages of intervention. The first stage was the application
of one or two tissue expanders, in which expanders were
applied under the normal (non-affected) scalp in the subgaleal
plane; expansion was then performed weekly for 3-4 months.
The second stage involved endovascular occlusion through
endovascular neuroradiology. The third stage was performed
the day after occlusion and included en bloc excision, the
delivery of tissue expanders, and reconstruction of the site of
excision using scalp flaps. The postoperative period was
uneventful. Six months to three years of following-up showed
no recurrence.
Conclusion:We conclude that the three-stage management
of large cirsoid aneurysms of the scalp (application of tissue
expanders, endovascular occlusion, then en bloc excision and
reconstruction) provides excellent results.