TREATMENT OF SCALP ARTERIOVENOUS MALFORMATION

WE REPORT SEVEN patients with scalp arteriovenous malformations, inclu ding two patients with lesions >10 cm in diameter, who were successful ly treated. The principal complaint of each patient was a deforming ma ss. Each of four patients had a history of blunt traumatic injury. The lesions, each consisting of the nidus, feeders, and draining veins, e volved in all patients. The nidus consisted of fistulae, which exhibit ed various angioarchitectures as revealed by angiography. A hemangioma tous component was histologically recognized in one patient. In five p atients, in whom the lesions were relatively small and whose nidi incl uded only large fistulae, the malformations were remedied by surgical intervention alone or were cured with embolization alone using liquid adhesives. In the two patients with lesions >10 cm, the nidi consisted of numerous large fistulae and plexiform fistulae in one patient and plexiform fistulae and a hemangiomatous component in the other patient . These patients were treated with a combination of transarterial embo lization and surgical intervention. Preoperative embolization greatly reduced blood loss during resection. Total excision and scalp reconstr uction using a soft tissue expander were performed in both patients. T he cosmetic results were excellent in all of the patients, and no recu rrence has been recognized during the follow-up period, which ranges f rom 31 to 99 months. The treatment of scalp arteriovenous malformation s should strive to improve deforming features and to attain a permanen t cure. Because each nidus includes a variety of anomalous angioarchit ectural features, there should be different means and a combination of treatments fbr each patient. Embolization alone could be adequate tre atment in relatively small lesions, the nidi of which consist only of several large fistulae. For malformations with more extensive, large f istulae or with anomalous components other than large fistulae, a comb ined endovascular and surgical approach and scalp reconstruction seems to be the best treatment.