Scalp Cirsoid Aneurysms: Case Illustration and Systematic Review of Literature

Abstract

Background: Scalp cirsoid aneurysms are rare subcutaneous arteriovenous fistulae affecting the scalp. They can be easily misdiagnosed and mistreated.

Objective: To review reported cases of scalp cirsoid aneurysms for their incidence, etiology, clinical presentation, treatment, and outcomes using an illustrative case.

Methods: We conducted a PUBMED, SCOPUS, OVID SP, SciELO, and INFORMA search using the keywords; "cirsoid," "aneurysm," "arteriovenous," "malformation," "scalp," "vascular," and "fistula." We identified 74 pertinent papers, reporting 242 cases in addition to our reported index case.

Results: Median age at presentation was 25 yr (range 1-72 yr); male to female ratio was 2.5:1. The most common symptoms were a pulsatile mass (94% of patients), headaches (25%), and tinnitus (20%). The median duration of symptoms was 3 yr (6 d to 31 yr), with 60.2% occurring spontaneously, 32.23% traumatic, and the rest iatrogenic. A total of 58.5% of cases were managed with surgical excision only, 21.6% with endovascular embolization only, and 14.5% with a combination of both methods. The complication rate observed in the endovascular embolization treatment cohort (55.8%) was significantly higher than that observed in the surgical excision only cohort (9.9%) (P < .00001) and in the combined therapy cohort (0%) (P < .00001). There is a low recurrence rate after treatment irrespective of modality: surgical excision only (6.3%), endovascular embolization only (8.3%), and combined therapy (0%).

Conclusion: Scalp cirsoid aneurysms are associated with good prognoses when recognized and managed appropriately. We suggest combining surgery with endovascular embolization as the optimum treatment modality.

Keywords: Aneurysm; Angiography; Arteriovenous; Cirsoid; Fistula; Subcutaneous.