Management of scalp arterio-venous malformation: case series and review of literature

Abstract

Objective. Evaluation of management strategies for scalp arterio-venous malformation (AVM). Materials and methods. A retrospective analysis of data of 31 patients with scalp AVM was carried out at all India Institute of medical sciences New Delhi between 1997 and 2010. All the patients except one underwent digital substraction angiography. Depending upon the size of AVM, we classified them in to three groups. Group 1 (small) size up to 4.9 cm, group 2 (medium) size 5–9.9 cm and group 3 (large) size more than 10 cm. Patients in group 1 and 2 underwent direct excision. Patients in group 3 underwent pre-operative embolization followed by surgical excision. Five patients refused any treatment. Patients were analysed to look into results, complications and recurrence in follow up. Results. There were 11 patients in group 1, 12 in group 2 and 8 in group 3. There were 18 males and 13 females with mean age of 25 years ranging from 13 to 55 years. The mean duration of symptom was 7.2 years. Angiography was performed in 30 patients. Superficial temporal artery (80.6%) was the most commonly involved. 18 patients underwent direct excision, 6 underwent embolization followed by excision and 2 underwent embolization. One patient in surgery group and two patients in embolization group had recurrence. One patient expired due to complications of hypotensive shock secondary to exsanguinating haemorrhage from AVM. Conclusion. Surgical excision has excellent outcome in treatment of scalp AVM. Pre-operative embolization reduces vascularity and helps in easy identification of AVM during surgery thus achieving complete excision. The size of AVM has no correlation with the number of feeding vessels. There are high chances of recurrence in large AVM after embolization.