1246. Traumatic Cirsoid Aneurysm of the Occipital Artery Treated by Embolization
Authors: Jason Milton, DO; Vadim Fuchs, DO (New Albany, OH)
Cirsoid aneurysms are rare arteriovenous fistulas of the scalp. Ten to twenty percent are due to trauma. Cirsoid aneurysms may be disfiguring and carry significant morbidity. Surgical excision has been reported to be effective, however deformity and blood loss are significant risks. Prior case series compare surgical excision to endovascular intervention, but have not considered many advances in intravascular approaches. This case details a Cirsoid aneurysm treated with embolization.
A 30 year-old male presented after blunt trauma to the head with a foreign object and a subsequent fall. Imaging revealed a small temporal epidural hematoma adjacent to a non-displaced skull fracture as well as multiple facial fractures and a displaced frontal sinus fracture requiring bifrontal craniotomy and exenteration of the frontal sinus. On Post-operative day ten, the patient complained of a worsening headache with an occipital pulsatile mass of the scalp. Computed tomography angiography demonstrated a 1.2 cm right occipital lesion consistent with a post-traumatic pseudoaneurysm without intracranial extension.
A right external carotid artery angiogram demonstrated a 1.6cm pseudoaneurysm of a distal branch of the right occipital artery. Particle embolization was successfully performed to achieve complete occlusion without complication. The patient discharged to home on post-procedure day one. At six-month follow up, repeat angiography was performed which revealed persistent occlusion. The patient remained neurologically intact and was without headaches.
Endovascular treatment of traumatic pseudoaneurysms is a viable treatment option that allows for less procedural morbidity. This case provides an example of endovascular treatment without complication. Particle embolization should be a consideration for primary treatment for traumatic pseudoaneurysms accessible via angiography.