Treatment of a Scalp Arteriovenous Malformation by a Combination of Embolization and Surgical Removal.

BACKGROUND

Scalp arteriovenous malformation is a rare disease. In terms of treatment, surgical removal is often effective and performed. With the development of endovascular treatments, a combination of surgical removal and embolization is now often performed.

CASE DESCRIPTION

A 44-year-old man presented with a mass in his left occipital region. Cerebral angiography led to a diagnosis of scalp arteriovenous malformation. Although he had no neurologic deficits, perfusion computed tomography (CT) scan showed a slight decrease in blood flow in the left cerebral hemisphere, which was presumed to have been caused by the scalp arteriovenous malformation. He suffered from a sleep disorder caused by tinnitus, and a discomfort with the lesion itself; therefore, we decided to surgically remove the lesion. To suppress intraoperative bleeding and safely perform the surgery, preoperative embolization was also planned. After treatment, he had no neurologic deficits and the sleep disorder improved. Perfusion CT scan performed after the surgery showed an improvement in cerebral blood flow in the left cerebral hemisphere.

CONCLUSIONS

Because cerebral blood flow may decrease depending on the progression of the lesion, the cerebral blood flow should be evaluated. Considering the treatment modalities depending on the lesion can provide treatment with less recurrence and higher patient satisfaction.