Al-Jehani Hosam, Mousa Ahmed Hafez, Fakhroo Fatima, Al Zahrani Basmah, Alaradi Basam
Department of Neurosurgery, Interventional Neuroradiology and Neuro-critical care, King Fahd Specialist Hospital, Dammam, Saudi Arabia; Department of Neurosurgery, Interventional Neuroradiology and Neuro-critical care, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, Weill Cornell University, Houston Methodist, United States of America.
Department of Neurosurgery, Interventional Neuroradiology and Neuro-critical care, King Fahd Specialist Hospital, Dammam, Saudi Arabia; Department of Neurosurgery, Interventional Neuroradiology and Neuro-critical care, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia; Neurosciences, Dubai Health, Dubai, United Arab Emirates; Department of Neurosurgery, Graduate Medical Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates.
Int J Surg Case Rep. 2025 Sep;134:111760. doi: 10.1016/j.ijscr.2025.111760. Epub 2025 Aug 5.
Scalp arteriovenous malformations (SAVMs) are rare high-flow vascular lesions with complex angioarchitecture, often involving both superficial and deep components. When the malformation extends toward the skull base or includes deep venous drainage, traditional transarterial or percutaneous access may be insufficient. While direct puncture techniques have gained traction, transosseous access via emissary veins has not previously been described.
A 12-year-old girl presented with a pulsatile, fluctuant swelling over the left forehead and localized headache. Imaging revealed a mixed-type SAVM involving the left sphenoid ridge, frontal bone, and scalp, supplied by the ophthalmic artery and cortical branches of the middle cerebral artery, with multiple draining veins. Due to tortuous arterial feeders and the risk of non-target embolization, conventional transarterial access was deemed unsafe. A transcalvarial micropuncture technique was employed through a burr hole targeting an emissary vein, granting direct access to a deep venous pouch. Under fluoroscopic guidance, detachable coils were deployed, achieving complete angiographic obliteration. The patient remained neurologically intact, with no complications and an excellent cosmetic outcome. Follow-up imaging at 1, 3, and 6 months showed no recurrence.
This case demonstrates the feasibility of using a transosseous emissary vein approach for embolization of complex SAVMs. When conventional access is limited, this technique offers precise, direct venous access with reduced morbidity.
This is the first reported case of SAVM embolization using transcalvarial micropuncture via an emissary vein. The technique presents a novel, safe, and effective adjunct in managing complex scalp AVMs involving the skull base.
头皮动静脉畸形（SAVM）是罕见的高流量血管病变，血管结构复杂，常累及浅表和深部成分。当畸形向颅底延伸或包括深部静脉引流时，传统的经动脉或经皮入路可能不足。虽然直接穿刺技术已受到关注，但经导静脉的经骨入路此前尚未见报道。
一名12岁女孩，左前额出现搏动性、波动性肿胀并伴有局部头痛。影像学检查显示为混合型SAVM，累及左蝶骨嵴、额骨和头皮，由眼动脉和大脑中动脉的皮质分支供血，有多个引流静脉。由于动脉供血迂曲且存在非靶栓塞风险，传统经动脉入路被认为不安全。采用经颅骨微穿刺技术，通过一个钻孔靶向一条导静脉，直接进入一个深部静脉囊袋。在透视引导下，植入可脱卸弹簧圈，实现血管造影完全闭塞。患者神经功能保持完好，无并发症，美容效果极佳。1个月、3个月和6个月的随访影像学检查显示无复发。
本病例证明了经骨导静脉入路用于栓塞复杂SAVM的可行性。当传统入路受限，该技术可提供精确、直接的静脉入路，且发病率较低。
这是首例经导静脉经颅骨微穿刺栓塞SAVM的报道病例。该技术为处理累及颅底的复杂头皮动静脉畸形提供了一种新颖、安全且有效的辅助方法。
