Intravascular embolization versus surgical resection for patients with scalp arteriovenous fistula

Abstract

Background: Scalp arteriovenous fistula (sAVF) is a rare vascular disease; so far, the standard guidelines for the treatment of sAVF are still unclear. Since its complex vascular anatomical structure, surgical management of sAVF remains an enormous challenge.

Methods: Between March 2016 and October 2017, three patients with sAVF admitted to the First Affiliated Hospital of Chongqing Medical University were reviewed, and clinical characteristics, imaging features, and surgical outcomes were analyzed.

Results: Three consecutive patients with sAVF were admitted to our hospital during the study period. Two patients received intravascular embolization and one patient received surgical resection. No procedure-related complications occurred after successfully treatment. During the long-term follow-up period, three patients recovered well and had no recurrence of lesion.

Conclusions: Either intravascular embolization or surgical resection is an effective therapy method for sAVF. Careful identification of angioarchitecture features contributes to successful treatment for the complex sAVF; therefore, it is recommended that neurosurgeons make the best treatment plan based on the location and number of the fistulas, feeding the artery, and draining the vein.

Keywords: Intravascular embolization; Scalp arteriovenous fistula; Surgical resection.

Fig. 1

a–c High-flow sAVF with arterial feeders from bilateral superficial temporal artery and left pulley artery, which drains into an enlarged scalp and facial venous. d–f Embolization therapy with Onyx-18 liquid material, and the almost occluded fistulous connections

Fig. 2

a–c sAVF having feeders from the markedly dilated bilateral occipital artery and superficial temporal artery, which drain into a tortuous superficial scalp vein. d–f After Onyx-18 liquid embolic material filling, almost occlusion of the fistulous connections

Fig. 3

a–c Selective cerebral angiography demonstrated the presence of sAVF in the right occipital scalp region and the single right occipital artery supplied blood to the drainage of occipital scalp vein. d–f Angiographic examination at 6 months after surgery showed no signs of fistula