1148. Multidisciplinary Treatment of a Giant Cirsoid Aneurysm

Authors: Mellissa Delcont; Tim Ung, MD; Salih Colakoglu, MD; Brooke French, MD; C. Corbett Wilkinson, MD (Aurora, CO)

Introduction: Scalp arteriovenous malformations, aka cirsoid aneurysms, are complex collections of directly communicating arteries and veins. Depending on their size and complexity, a variety of strategies may be used to treat them. We present the case of a giant cirsoid aneurysm treated with endovascular embolization, resection, and reconstruction using multiple expanded scalp and facial flaps. Methods: A 19-year-old male presented with a pulsatile left temporal scalp mass that had slowly grown to involve most of the left scalp and extend into the ipsilateral face. He had recently developed episodic lateral visual field loss as well as photophobia, headaches, and vertigo. Catheter angiography demonstrated an extensive AVM supplied primarily by the left superficial temporal, posterior auricular, and occipital arteries, as well as the ophthalmic artery and a dural arteriovenous fistula. The patient underwent endovascular embolization followed by resection and reconstruction of the tissue defect using multiple expanded scalp and facial flaps. Tissue expanders were placed in the vertex, occipital, and left lower facial regions. Results: The patient recovered well without neurological deficits and had complete resolution of his symptoms. Two months after surgery, his scars were healing well, and the surgical site was free of pulsations. His hairline and overall facial symmetry were preserved. Conclusion: As a cirsoid aneurysm grows, it may recruit blood supply from multiple intracranial and extracranial vessels and involve both scalp and facial tissue. Large cirsoid aneurysms may require multidisciplinary treatment combining embolization, resection, and plastic surgical techniques to close tissue defects.