Scalp arteriovenous malformation with dual bilateral arterial feeders: Case report and review of literature

Abstract

Background: Arteriovenous malformation of the scalp (sAVM) is a rare pathology that accounts for 8% of all cranial arteriovenous malformations. It is believed to be congenital; however, few reported were secondary to trauma. They are managed either via surgical resection, endovascular embolization, or combined approach. Cases with bilateral dual extracranial feeders are yet significantly scarce incidents among this rare pathology. We report a case of sAVM with dual bilateral feeders and review the literature. Case presentation: We report a case of a 24-year-old male who presented with a spontaneous para-midline enlarging mass over five years associated with headache. Imaging, including angiography, showed a subcutaneous vascular lesion measuring 2.4x4.2 cm supplied by bilateral superficial temporal arteries and occipital arteries. The patient underwent endovascular subtotal embolization with subsequent surgical excision with excellent recovery. Conclusion: The rare occurrence of sAVMs requires a high index of suspicion and angiographic images to assess blood supply for preoperative embolization. A combined management approach is associated with good outcome and decrease the risk of recurrence.

Keywords

• Scalp
• Arteriovenous malformation
• Cirsoid aneurysm
• Embolization
• Surgery