CIRSOID ANEURYSM TREATMENT BY PERCUTANEOUS INJECTION OF SODIUM TETRADECYL SULFATE

BACKGROUND Cirsoid aneurysms are uncommon arteriovenous fistulas of th e scalp. Surgery for these lesions can be difficult; transarterial emb olization is rarely curative, while embolization of the venous pouch w ith permanent agents usually necessitates subsequent surgical removal of the embolic material, The ideal embolic agent would be one that is safe and effective, commercially available, and would not require subs equent removal. METHODS We treated an arteriovenous fistula of the sca lp with direct puncture and injection of sodium tetradecyl sulfate, a commercially available sclerosing agent. RESULTS Control angiography i mmediately following percutaneous injection of sotradecol into the fis tula showed decreased flow but not complete closure of the lesion. How ever, within several days of the embolization, the patient's scalp pai n and mass resolved. Four months after embolization, MRA demonstrated no evidence of residual or recurrent fistula. Color doppler flow imagi ng demonstrated only slightly decreased vascular resistance in the dis tal superficial temporal artery, possibly indirect evidence of persist ent micro-fistulae. Twenty-three months after the procedure, the patie nt continued to be asymptomatic and had no palpable lesion. CONCLUSION S Percutaneous injection of sotradecol can be considered as one of the treatment options for arteriovenous fistula of the scalp. Further exp erience is needed to compare the safety and effectiveness of sotradeco l with other agents currently used in the treatment of scalp arteriove nous fistulae. (C) 1996 by Elsevier Science Inc.