Results of surgical excision of cirsoid aneurysm of the scalp without preoperative interventions

Abstract

Context: Cirsoid aneurysms of scalp are rare lesions which are mainly treated by surgical excision. Endovascular embolization was described either alone or prior to surgery in order to minimize the risk of bleeding. However, the endovascular therapy also carries the risk of scalp necrosis, escape of embolization material to circulation, and recurrence of the lesion.

Aim: To evaluate the results of well-planned classic surgical excision of cirsoid aneurysm.

Study design: This is a retrospective case series study.

Materials and methods: This is a retrospective case series study on nine patients with cirsoid aneurysms who were treated with surgical excision. Preoperative Planning for location, size, feeding arteries, and venous drainage of the lesions were done by plain and contrast enhanced CT, MRI, MR angiogram, and selective internal and external carotid angiograms. Complete surgical excision for the lesions was done. Postoperative evaluation of excision was done by cranial magnetic resonance angiography in all the patients. The mean follow up period was 34.1 (±7.62 STD) months.

Results: The lesion was located in the occipital region in three (33.3%) cases, frontal region in two (22.2%) cases, temproparietal region in two (22.2%) cases, parietal region in one case (11.1%), and vertex in one case (11.1%). The superficial temporal artery was involved in seven (77.8%) cases, the occipital artery was involved in six (66.7%) cases, the posterior auricular artery was involved in five (55.6%) cases, the supraorbital artery was involved in two (22.2%) cases and the middle meningeal artery was involved in two (22.2%) cases. Total excision of the lesion was achieved in eight patients and en bloc resection and primary closure was done in one patient. Postoperative magnetic resonance angiogram showed no residual lesion in all patients. No postoperative complication related to the surgery had occurred. No recurrence had occurred during the follow-up period (mean 34.1 ± 7.62 STD months).

Conclusion: Well-planned surgery of cirsoid aneurysm of the scalp without preoperative interventions could achieve complete excision of the lesion without any residual masses or recurrence and with a low incidence of complications.

Keywords: Arteriovenous fistula; cirsoid aneurysm; scalp; vascular malformation.

Figure 1

Two patients with cirsoid aneurysm (a) in the middle of forehead and (b) in the left occipital region presented as pulsatile swelling with bruit and thrill

Figure 2

(a) CT and (b and c) MRI pictures of scalp cirsoid aneurysm in different patients

Figure 3

MR angiogram of left occipital cirsoid aneurysm showing (a) feeding from the occipital and posterior auricular arteries and (b) draining into sigmoid and internal jagular veins

Figure 4

Surgical excision of scalp cirsoid aneurysm. (a) Injection of local anesthetic solution with adrenaline at the site of skin incision. (b) The large vessels entering the aneurysm are individually ligated and divided as they were encountered in the incision. (c) The galea around the lesion is incised and the lesion is separated from the underlying skin. (d) The lesion is progressively separated from the underlying skin and totally excised

Figure 5

Small scalp cirsoid aneurysm with thin overlying skin was treated with en bloc resection and primary closure of the scalp

Figure 6

Postoperative photographs of patients with (a) frontal and (b) occipital cirsoid aneurysms that excised surgically with good postoperative cosmetic result