Successful en bloc resection with acceptable cosmesis of a right recurrent giant scalp-orbital AVM causing severe disfigurement: a case report
Abstract
Scalp arteriovenous malformation (AVM) accounts for only 8.1% of all AVM cases. These lesions are made up of an abnormal fistulous tangle of tortuous dysmorphic network of vessels “vascular nidus” directly connecting between the feeding arteries and draining veins, without capillary connection, located within the incision subcutaneous layer.With time, these congenital lesions may evolve and enlarge and clinically manifest with variable features. The only effective method of preventing evolution of these malformations is to exclude the lesion completely from the circulation. Involvement of the orbit and face may cause severe facial disfigurement, proptosis, visual obstruction and even facial palsy. These lesions may be complicated by ulceration, infection and profuse bleeding.
We present a rare case of 40-year-old female with a recurrent congenital scalp-orbital AVM causing proptosis, visual obstruction on the right eye with severe facial disfigurement. The lesion was successfully excised with acceptable cosmesis and removal of the visual obstruction. A brief literature review, imaging findings and the surgical techniques have been presented.
References
1.Worm PV, Ruschel LG, Roxo MR, Camelo R. Giant scalp arteriovenous malformation. Rev Assoc Med Bras (1992). 2016 Dec;62(9):828-30.
2.Khodadad G. Arteriovenous malformations of the scalp. Ann Surg. 1973 Jan;177(1):79-85.
3.Fisher-Jeffes ND, Domingo Z, Madden M, de Villiers JC. Arteriovenous malformations of the scalp. Neurosurgery. 1995 Apr;36(4):656-60.
4.Muthukumar N, Rajagopal V, Manoharan AV, Durairaj N. Surgical management of cirsoid aneurysms. Acta Neurochir (Wien). 2002 Apr;144(4):349-56.
5.Wilkinson HA. Recurrence of vascular malformation of the scalp 18 years following excision. Case report. J Neurosurg. 1971 Mar;34(3):435-7.
6.Barnwell SL, Halbach VV, Dowd CF, Higashida RT, Hieshima GB. Endovascular treatment of scalp arteriovenous fistulas associated with a large varix. Radiology. 1989 Nov;173(2):533-9.
7.Lanzino G, Passacantilli E, Lemole GM Jr, McDougall C, Spetzler RF. Scalp arteriovenous malformation draining into the superior sagittal sinus associated with an intracranial arteriovenous malformation: just a coincidence? Case report. Neurosurgery. 2003 Feb;52(2):440-3.
8.Matsushige T, Kiya K, Satoh H, Mizoue T, Kagawa K, Araki H. Arteriovenous malformation of the scalp: case report and review of the literature. Surg Neurol. 2004 Sep;62(3):253-9.
9.El Shazly AA, Saoud KM. Results of surgical excision of cirsoid aneurysm of the scalp without preoperative interventions. Asian J Neurosurg. 2012 Oct;7(4):191-6.
10.Nishijima I, Ikemura R, Gushiken M, Miyagi K, Iha K. Nonsurgical treatment of scalp arteriovenous malformation using a combination of ultrasound-guided thrombin injection and transarterial coil embolization. J Vasc Surg. 2012 Mar;55(3):833-6.
11.Dmytriw AA, Ter Brugge KG, Krings T, Agid R. Endovascular treatment of head and neck arteriovenous malformations. Neuroradiology. 2014 Mar;56(3):227-36.
12.Munakomi S, Bhattarai B, Cherian I. Conquering the odds: Cirsoid aneurysm with holocranial feeders-staged embolization, excision and grafting. Asian J Neurosurg. 2015 Jul-Sep;10(3):259-61.
13.Hendrix LE, Meyer GA, Erickson SJ. Cirsoid aneurysm treatment by percutaneous injection of sodium tetradecyl sulfate. Surg Neurol. 1996 Dec;46(6):557-60.
14.Hage ZA, Few JW, Surdell DL, Adel JG, Batjer HH, Bendok BR. Modern endovascular and aesthetic surgery techniques to treat arteriovenous malformations of the scalp: case illustration. Surg Neurol. 2008 Aug;70(2):198-203.
15.Godwin O, Ayotunde O, Millicent O, Yvonne O: Extracranial arteriovenous malformation of thescalp: value of computed tomographic angiography. The Internet Journal of Radiology 2006;5:1.
16.Senoglu M, Yasim A, Gokce M, Senoglu N. Nontraumatic scalp arteriovenous fistula in an adult: technical report on an illustrative case. Surg Neurol. 2008 Aug;70(2):194-7.
17.Chowdhury FH, Haque MR, Kawsar KA, Sarker MH, Momtazul Haque AF. Surgical management of scalp arterio-venous malformation and scalp venous malformation: An experience of eleven cases. Indian J Plast Surg. 2013 Jan;46(1):98-107.
18.Raheja A, Satyarthee GD, Sharma BS. Single, small, spontaneous, accessory, closed type, frontal sinus pericranii in a child: favorable outcome with surgical excision. Neurol India. 2013 Nov-Dec;61(6):680-3.
19.Rane SY, Lamba S, Gohil AJ, Gupta AK. Compendium of scalp arteriovenous malformation (AVM) cases—a retrospective study and review. European Journal of Plastic Surgery 2017;41:223-8.
20.Shenoy SN, Raja A. Scalp arteriovenous malformations. Neurol India. 2004 Dec;52(4):478-81.
21.Massimi L, De Bonis P, Esposito G, Novegno F, Pettorini B, Tamburrini G, Caldarelli M, Di Rocco C. Vertex scalp mass as presenting sign of a complex intracranial vascular malformation. J Neurosurg Pediatr. 2009 Apr;3(4):307-10.
22.Schultz RC, Hermosillo CX. Congenital arteriovenous malformation of the face and scalp. Plast Reconstr Surg [Internet]. 1980;65(4).
23.Domingo Z, Fisher-Jeffes ND, de Villiers JC. Surgical management of arteriovenous malformations of the scalp. In: Shmidek HN, editor. Operative Neurosurgical Techniques: Indications, Methods and Results. 4th ed. Philadelphia: Saunders Company; 2000. pp. 1331–1338.
24.Souder DE, Bercaw BL. Arteriovenous fistula secondary to hair transplantation. N Engl J Med. 1970 Aug 27;283(9):473-4.
25.Barros d'Sa AA, Heard CE. Arteriovenous fistula after hair transplantation. Br Med J. 1978 Feb 11;1(6109):340-1.
26.Lanzieri CF, Sacher M, Som PM, Haimov M. Arteriovenous fistula after hair transplantation. AJNR Am J Neuroradiol. 1985 Jan-Feb;6(1):111-2.
27.Liounakos JI, Urakov T, Snelling B, Peterson EC. Scalp arteriovenous fistula following hair transplantation: acase Report and review of the literature. Clin Med Rev Case Rep. 2018;5:200.
28.Li F, Zhu S, Liu Y, Chen Y, Chi L, Chen G, Zhang J, Qu F. Traumatic arteriovenous fistula of the superficial temporal artery. J Clin Neurosci. 2007 Jun;14(6):595-600.
29.Mast H, Mohr JP, Osipov A, Pile-Spellman J, Marshall RS, Lazar RM, Stein BM, Young WL. 'Steal' is an unestablished mechanism for the clinical presentation of cerebral arteriovenous malformations. Stroke. 1995 Jul;26(7):1215-20.
30.Kasdon DL, Altemus LR, Stein BM. Embolization of a traumatic arteriovenous fistula of the scalp with radiopaque Gelfoam pledgets. Case report and technical note. J Neurosurg. 1976 Jun;44(6):753-6.
31.Hochberg J, Ardenghy M, Pait TG. Scalp tourniquet. Br J Plast Surg. 1994 Apr;47(3):194-8.
32.Gupta AK, Purkayastha S, Bodhey NK, Kapilamoorthy TR, Krishnamoorthy T, Kesavadas C, Thomas B. Endovascular treatment of scalp cirsoid aneurysms. Neurol India. 2008 Apr-Jun;56(2):167-72.
33.Burrus TM, Miller GM, Flynn LP, Fulgham JR, Lanzino G. NeuroImages. Symptomatic left temporal arteriovenous traumatic fistula. Neurology. 2009 Aug 18;73(7):570.
34.Manuel AM, Kalimuthu S, Pathmanathan SS, Narayanan P, Zainal Abidin Z, Azmi K, Khalil A. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis. Asian J Surg. 2017 Apr;40(2):158-62.
35.Hasturk AE, Erten F, Ayata T. Giant non-traumatic arteriovenous malformation of the scalp. Asian J Neurosurg. 2012 Jan;7(1):39-41.
36.Shepard RH. Proceedings: Cirsoid arteriovenous malformations of the scalp. J Neurol Neurosurg Psychiatry. 1975 Aug;38(8):827-8.
37.Nagasaka S, Fukushima T, Goto K, Ohjimi H, Iwabuchi S, Maehara F. Treatment of scalp arteriovenous malformation. Neurosurgery. 1996 Apr;38(4):671-7.
38.Weinzweig N, Chin G, Polley J, Charbel F, Shownkeen H, Debrun G. Arteriovenous malformation of the forehead, anterior scalp, and nasal dorsum. Plast Reconstr Surg. 2000 Jun;105(7):2433-9.
39.Gardner AM, Stewart IA. Treatment of arteriovenous malformation by endarterial electrocoagulation. Br J Surg. 1972 Feb;59(2):146-8.
40.Heilman CB, Kwan ES, Klucznik RP, Cohen AR. Elimination of a cirsoid aneurysm of the scalp by direct percutaneous embolization with thrombogenic coils. Case report. J Neurosurg. 1990 Aug;73(2):296-300.
41.Komiyama M, Nishikawa M, Kitano S, Sakamoto H, Imai K, Tsujiguchi K, Mizuno T. Non-traumatic arteriovenous fistulas of the scalp treated by a combination of embolization and surgical removal. Neurol Med Chir (Tokyo). 1996 Mar;36(3):162-5.
42.Tanaka T, Hasegawa Y, Kanki T, Hayashi J, Ui K, Usami S, Abe T. [Combination of intravascular surgery and surgical operation for occipital subcutaneous arteriovenous fistula in a patient with neurofibromatosis type I]. No Shinkei Geka. 2002 Mar;30(3):309-13. [Article in Japanese].
43.Cognard C, Januel AC, Silva NA Jr, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008 Feb;29(2):235-41.
2.Khodadad G. Arteriovenous malformations of the scalp. Ann Surg. 1973 Jan;177(1):79-85.
3.Fisher-Jeffes ND, Domingo Z, Madden M, de Villiers JC. Arteriovenous malformations of the scalp. Neurosurgery. 1995 Apr;36(4):656-60.
4.Muthukumar N, Rajagopal V, Manoharan AV, Durairaj N. Surgical management of cirsoid aneurysms. Acta Neurochir (Wien). 2002 Apr;144(4):349-56.
5.Wilkinson HA. Recurrence of vascular malformation of the scalp 18 years following excision. Case report. J Neurosurg. 1971 Mar;34(3):435-7.
6.Barnwell SL, Halbach VV, Dowd CF, Higashida RT, Hieshima GB. Endovascular treatment of scalp arteriovenous fistulas associated with a large varix. Radiology. 1989 Nov;173(2):533-9.
7.Lanzino G, Passacantilli E, Lemole GM Jr, McDougall C, Spetzler RF. Scalp arteriovenous malformation draining into the superior sagittal sinus associated with an intracranial arteriovenous malformation: just a coincidence? Case report. Neurosurgery. 2003 Feb;52(2):440-3.
8.Matsushige T, Kiya K, Satoh H, Mizoue T, Kagawa K, Araki H. Arteriovenous malformation of the scalp: case report and review of the literature. Surg Neurol. 2004 Sep;62(3):253-9.
9.El Shazly AA, Saoud KM. Results of surgical excision of cirsoid aneurysm of the scalp without preoperative interventions. Asian J Neurosurg. 2012 Oct;7(4):191-6.
10.Nishijima I, Ikemura R, Gushiken M, Miyagi K, Iha K. Nonsurgical treatment of scalp arteriovenous malformation using a combination of ultrasound-guided thrombin injection and transarterial coil embolization. J Vasc Surg. 2012 Mar;55(3):833-6.
11.Dmytriw AA, Ter Brugge KG, Krings T, Agid R. Endovascular treatment of head and neck arteriovenous malformations. Neuroradiology. 2014 Mar;56(3):227-36.
12.Munakomi S, Bhattarai B, Cherian I. Conquering the odds: Cirsoid aneurysm with holocranial feeders-staged embolization, excision and grafting. Asian J Neurosurg. 2015 Jul-Sep;10(3):259-61.
13.Hendrix LE, Meyer GA, Erickson SJ. Cirsoid aneurysm treatment by percutaneous injection of sodium tetradecyl sulfate. Surg Neurol. 1996 Dec;46(6):557-60.
14.Hage ZA, Few JW, Surdell DL, Adel JG, Batjer HH, Bendok BR. Modern endovascular and aesthetic surgery techniques to treat arteriovenous malformations of the scalp: case illustration. Surg Neurol. 2008 Aug;70(2):198-203.
15.Godwin O, Ayotunde O, Millicent O, Yvonne O: Extracranial arteriovenous malformation of thescalp: value of computed tomographic angiography. The Internet Journal of Radiology 2006;5:1.
16.Senoglu M, Yasim A, Gokce M, Senoglu N. Nontraumatic scalp arteriovenous fistula in an adult: technical report on an illustrative case. Surg Neurol. 2008 Aug;70(2):194-7.
17.Chowdhury FH, Haque MR, Kawsar KA, Sarker MH, Momtazul Haque AF. Surgical management of scalp arterio-venous malformation and scalp venous malformation: An experience of eleven cases. Indian J Plast Surg. 2013 Jan;46(1):98-107.
18.Raheja A, Satyarthee GD, Sharma BS. Single, small, spontaneous, accessory, closed type, frontal sinus pericranii in a child: favorable outcome with surgical excision. Neurol India. 2013 Nov-Dec;61(6):680-3.
19.Rane SY, Lamba S, Gohil AJ, Gupta AK. Compendium of scalp arteriovenous malformation (AVM) cases—a retrospective study and review. European Journal of Plastic Surgery 2017;41:223-8.
20.Shenoy SN, Raja A. Scalp arteriovenous malformations. Neurol India. 2004 Dec;52(4):478-81.
21.Massimi L, De Bonis P, Esposito G, Novegno F, Pettorini B, Tamburrini G, Caldarelli M, Di Rocco C. Vertex scalp mass as presenting sign of a complex intracranial vascular malformation. J Neurosurg Pediatr. 2009 Apr;3(4):307-10.
22.Schultz RC, Hermosillo CX. Congenital arteriovenous malformation of the face and scalp. Plast Reconstr Surg [Internet]. 1980;65(4).
23.Domingo Z, Fisher-Jeffes ND, de Villiers JC. Surgical management of arteriovenous malformations of the scalp. In: Shmidek HN, editor. Operative Neurosurgical Techniques: Indications, Methods and Results. 4th ed. Philadelphia: Saunders Company; 2000. pp. 1331–1338.
24.Souder DE, Bercaw BL. Arteriovenous fistula secondary to hair transplantation. N Engl J Med. 1970 Aug 27;283(9):473-4.
25.Barros d'Sa AA, Heard CE. Arteriovenous fistula after hair transplantation. Br Med J. 1978 Feb 11;1(6109):340-1.
26.Lanzieri CF, Sacher M, Som PM, Haimov M. Arteriovenous fistula after hair transplantation. AJNR Am J Neuroradiol. 1985 Jan-Feb;6(1):111-2.
27.Liounakos JI, Urakov T, Snelling B, Peterson EC. Scalp arteriovenous fistula following hair transplantation: acase Report and review of the literature. Clin Med Rev Case Rep. 2018;5:200.
28.Li F, Zhu S, Liu Y, Chen Y, Chi L, Chen G, Zhang J, Qu F. Traumatic arteriovenous fistula of the superficial temporal artery. J Clin Neurosci. 2007 Jun;14(6):595-600.
29.Mast H, Mohr JP, Osipov A, Pile-Spellman J, Marshall RS, Lazar RM, Stein BM, Young WL. 'Steal' is an unestablished mechanism for the clinical presentation of cerebral arteriovenous malformations. Stroke. 1995 Jul;26(7):1215-20.
30.Kasdon DL, Altemus LR, Stein BM. Embolization of a traumatic arteriovenous fistula of the scalp with radiopaque Gelfoam pledgets. Case report and technical note. J Neurosurg. 1976 Jun;44(6):753-6.
31.Hochberg J, Ardenghy M, Pait TG. Scalp tourniquet. Br J Plast Surg. 1994 Apr;47(3):194-8.
32.Gupta AK, Purkayastha S, Bodhey NK, Kapilamoorthy TR, Krishnamoorthy T, Kesavadas C, Thomas B. Endovascular treatment of scalp cirsoid aneurysms. Neurol India. 2008 Apr-Jun;56(2):167-72.
33.Burrus TM, Miller GM, Flynn LP, Fulgham JR, Lanzino G. NeuroImages. Symptomatic left temporal arteriovenous traumatic fistula. Neurology. 2009 Aug 18;73(7):570.
34.Manuel AM, Kalimuthu S, Pathmanathan SS, Narayanan P, Zainal Abidin Z, Azmi K, Khalil A. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis. Asian J Surg. 2017 Apr;40(2):158-62.
35.Hasturk AE, Erten F, Ayata T. Giant non-traumatic arteriovenous malformation of the scalp. Asian J Neurosurg. 2012 Jan;7(1):39-41.
36.Shepard RH. Proceedings: Cirsoid arteriovenous malformations of the scalp. J Neurol Neurosurg Psychiatry. 1975 Aug;38(8):827-8.
37.Nagasaka S, Fukushima T, Goto K, Ohjimi H, Iwabuchi S, Maehara F. Treatment of scalp arteriovenous malformation. Neurosurgery. 1996 Apr;38(4):671-7.
38.Weinzweig N, Chin G, Polley J, Charbel F, Shownkeen H, Debrun G. Arteriovenous malformation of the forehead, anterior scalp, and nasal dorsum. Plast Reconstr Surg. 2000 Jun;105(7):2433-9.
39.Gardner AM, Stewart IA. Treatment of arteriovenous malformation by endarterial electrocoagulation. Br J Surg. 1972 Feb;59(2):146-8.
40.Heilman CB, Kwan ES, Klucznik RP, Cohen AR. Elimination of a cirsoid aneurysm of the scalp by direct percutaneous embolization with thrombogenic coils. Case report. J Neurosurg. 1990 Aug;73(2):296-300.
41.Komiyama M, Nishikawa M, Kitano S, Sakamoto H, Imai K, Tsujiguchi K, Mizuno T. Non-traumatic arteriovenous fistulas of the scalp treated by a combination of embolization and surgical removal. Neurol Med Chir (Tokyo). 1996 Mar;36(3):162-5.
42.Tanaka T, Hasegawa Y, Kanki T, Hayashi J, Ui K, Usami S, Abe T. [Combination of intravascular surgery and surgical operation for occipital subcutaneous arteriovenous fistula in a patient with neurofibromatosis type I]. No Shinkei Geka. 2002 Mar;30(3):309-13. [Article in Japanese].
43.Cognard C, Januel AC, Silva NA Jr, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008 Feb;29(2):235-41.
Published
2021-12-13
How to Cite
KARKI, Anjan Singh et al.
Successful en bloc resection with acceptable cosmesis of a right recurrent giant scalp-orbital AVM causing severe disfigurement: a case report.
J Soc Surg Nep, [S.l.], v. 24, n. 1, p. 28-33, dec. 2021.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=404>. Date accessed: 01 dec. 2023.
Section
Case Reports
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright and Open Access Policy
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
JSSN applies the Creative Commons Attribution (CC BY) license to all works we publish. Under the CC BY license, authors retain ownership of the copyright for their article, but authors allow anyone to download, reuse, reprint, distribute, and/or copy articles in JSSN, so long as the original authors and source are cited. No permission is required from the authors or the publishers.
Article by JSSN is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://www.jssn.org.np/index.php?journal=jssn.
