Percutaneous embolization of a scalp arteriovenous malformation: Case report

Scalp arteriovenous malformations (AVM) are uncommon high flow cervicofacial vascular malformations. They can progressively increase in size causing scalp necrosis and bleeding with substantial aesthetic disturbances. Complete surgical excision may induce severe intraoperative blood loss and the need for skin reconstruction procedures. Herein we report a case of a nine-year-old girl with a right fronto-parietal scalp AVM composed of large arteriovenous fistulas supplied by both superficial temporal artery and right sovra-orbital branch of the right ophthalmic artery treated with endovascular techniques. The treatment was performed first by transarterial embolization of the frontoparietal branch of the right superficial temporal artery with 250-350 micron polyvinyl alcohol particles in order to reduce blood flow. This was followed by percutaneous tranvenous embolization of the main draining veins with a mixture of 50% of n-butyl cyanoacrylate and 50% of iodised oil. Percutaneous transvenous embolization was performed using a road mapping technique after venous compression obtained with a haemostatic loop. A complete obliteration of AVM without complications was obtained. The patient was clinically cured at a follow up of one year.