Management of Large Cirsoid Aneurysms of the Scalp using Tissue Expanders, Intravascular Occlusion, and En Bloc Excision

Nagy E, Setta HS and Elshahat A

Department of Plastic Surgery, Ain Shams University, Egypt

^*Correspondance to: Ahmed Elshahat 

 PDF  Full Text DOI: 10.25107/2474-1647.1049

Abstract

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. The aim of this work is to present the successful management of cirsoid aneurysms of the scalp using tissue expanders, endovascular occlusion, and en bloc excision. 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. 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.

Keywords

Cirsoid aneurysm; Vascular malocclusion; Tissue expansion; Endovascular occlusion; Scalp

Cite the article

Nagy E, Setta HS, Elshahat A. Management of Large Cirsoid Aneurysms of the Scalp using Tissue Expanders, Intravascular Occlusion, and En Bloc Excision. Clin Surg. 2016; 1: 1049.