Experience of treatment of patients with posttraumatic scalp arteriovenous malformations
Objective – to improve results of treatment of patients with scalp arteriovenous malformations.
Materials and methods. Results of treatment of three patients (two male 27 and 36 years old and one famale of 32 years old) with posttraumatic scalp arteriovenous malformations were analysed. The main method for verifying the diagnosis was selective cerebral angiography, Endovascular embolization and surgical resection was used in two cases, and in one case endovascular embolization was used alone.
Results. In all cases the appearance of clinical manifestations was preceded by a local injury of scalp. In all patients posttraumatic malformations were localized along the midline in the projection of the intersection of sagittal and coronary sutures. The period between the onset of clinical symptoms and surgery in two cases was 3 years, in one case – 30 years. In all patients the predominant source of malformations filling was unilateral superficial temporal artery, which formed anastomosis with a contralateral superficial temporal artery, middle meningeal artery and meningeal branches of the ophtalmic artery. In two cases, malformations was an abnormally enlarged angiomatous net of small arteries without visible direct arteriovenous drainage, in one case it was direct arteriovenous shunt. In all cases the endovascular embolization of the malformations was utilized, in two cases – the surgical removal of the malformations was performed. We didn't seen any complications during the intervention. The complete occlusion of malformations with a satisfied cosmetic effect was achieved.
Conclusions. Posttraumatic scalp arteriovenous malformations have heterogeneous structure. The choice of optimal management depends on the type of the malformations. In cases of direct arteriovenous shunt the method of choice should be endovascular occlusion, and in cases of angiomatous net the embolization should be supplemented by the surgical resection of the malformations.
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