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Case Reports
. 2021 May 25:12:238.
doi: 10.25259/SNI_263_2021. eCollection 2021.

Delayed presentation of a traumatic scalp arteriovenous fistula

Josue D Ordaz  1 , Nicolas W Villelli  1 , Bradley N Bohsntedt  1 , Laurie L Ackerman  1
Affiliations
Case Reports

Delayed presentation of a traumatic scalp arteriovenous fistula

Josue D Ordaz et al. Surg Neurol Int. .

Abstract

Background: Arteriovenous (AV) fistulas of the scalp are extracranial vascular malformations commonly caused by trauma and typically present within 3 years. Although they follow a benign course, they can be esthetically displeasing.

Case description: We present an atypical onset of scalp AV fistula in a patient with a 1-year history of the left-sided pulsatile tinnitus and scalp swelling 7 years after a traumatic epidural hematoma evacuation. Our patient was found to have an 8 mm AV fistula supplied by the deep temporal artery. Endovascular embolization was performed using eight coils. There was no complication from the procedure, and the patient's pulsatile tinnitus and swelling resolved immediately after embolization. Follow-up angiogram demonstrated complete obliteration of the AV fistula.

Conclusion: Delayed presentation of traumatic scalp AV fistula is very rare, and it is important to keep this in the differential in patients with scalp swelling after head trauma.

Keywords: Arteriovenous fistula; Head trauma; Iatrogenic fistula; Neuroendovascular.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Initial head CT after trauma 7 years before AV fistula development. (a) L temporal epidural hematoma with 0.5 cm midline shift. (b) Postoperative CT scan demonstrating evacuation of EDH and improvement of midline shift.
Figure 2:
Figure 2:
Engorged left temporal vessels 7 years following traumatic epidural hematoma evacuation. (a and b) Clinical presentation of the left anterolateral scalp swelling. (c and d) CTA head 7 years after initial trauma demonstrated scalp engorged vessels.
Figure 3:
Figure 3:
Pre- and post-embolization angiogram. (a, b, c) AP, lateral, and selective internal maxillary angiogram demonstrating the deep temporal arterial feeders, venous pouch, and venous drainage. (d, e, f) Postoperative angiogram demonstrating obliteration of the AV fistula after embolization.
Figure 4:
Figure 4:
Six-month follow-up angiogram. (a) Lateral image of the left ICA. (b) AP image of the left internal maxillary artery (IMA). (c) Oblique view of IMA.
See this image and copyright information in PMC

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