Multimodal Treatment Approach for a Recurrent Hemorrhagic Scalp Arteriovenous Fistula: A Case Report.

Scalp arteriovenous fistula (AVF) is a rare vascular malformation that may present as a pulsatile scalp mass with complications like hemorrhage. We report a case of a large scalp AVF with recurrent bleeding, managed successfully with a multimodal approach. A 46-year-old man presented with a recurrently bleeding pulsatile scalp mass in the left temporal region, initially diagnosed as AVF following trauma. Imaging revealed an 80-mm lesion, and staged treatment included embolization, direct n-butyl-2-cyanoacrylate (NBCA) injection, resection, and skin grafting. Postoperative infective endocarditis required mitral valve replacement and prolonged antibiotics. At one-year follow-up, no AVF recurrence was observed. Scalp AVFs can lead to serious complications if untreated. This case demonstrates successful management through embolization and excision, highlighting the importance of individualized treatment strategies based on lesion complexity.