Compendium of scalp arteriovenous malformation (AVM) cases—a retrospective study and review

Background: Arteriovenous malformations (AVMs) are abnormal connections between arterial feeding vessels and draining veins, devoid of a normal capillary bed. Treatment options include complete surgical excision or eradication. Following surgical excision, the defect can be closed primarily or covered with the preplanned local flap or skin graft. We aimed to assess various cases of AVMs and review the current literature to determine a treatment rationale and improve surgical outcomes. Methods: A retrospective study including data of 21 patients with extra cranial scalp AVMs was carried out at our institute between 2010 and 2016. Fourteen patients underwent digital subtraction angiography; remaining patients were evaluated by MR/CT angiography. Eighteen patients underwent direct excision. Three patients with large AVMs (> 10 cm) underwent preoperative embolization followed by surgical excision. Results: Of the 21 patients with extra cranial scalp AVMs, there were 11 males and 10 females with mean age of 24 years ranging from 3 to 41 years. The mean duration of symptom was 6.7 years. Superficial temporal artery (62%) was the most commonly involved feeder vessel. Eighteen patients underwent direct excision while three underwent embolization followed by excision. Two patients had recurrence of symptoms. There was partial flap necrosis in three patients which were managed with dressings and skin graft. Conclusions: Surgical excision of AVMs, which includes ligation of all arterial feeders near the nidus and excision of nidus, is a safe option with lesser complications and gives good results. Preoperative embolization reduces vascularity and helps in easy identification of AVMs during surgery thus achieving complete excision and improving the prognosis of treatment especially in the large AVM. Level of Evidence: Level IV, therapeutic study. © 2017, Springer-Verlag GmbH Germany.