Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Images in Neurosciences
3 (
1
); 95-96
doi:
10.4103/0976-3147.91976

Cirsoid aneurysm of scalp

Department of Surgery, Fr. Muller Medical College Hospital, Kankanady, Mangalore, India
Department of Neurosurgery, Fr. Muller Medical College Hospital, Kankanady, Mangalore, India

Address for correspondence: Dr. Leo Francis Tauro, Department of General Surgery, Fr. Muller Medical College Hospital, Kankanady, Mangalore – 575 002, Karnataka, India. E-mail: drlftauro@rediffmail.com

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

A 40-year-old lady presented with swelling on the right side of the scalp associated with continuous headache for 1 month. Her general physical examination was normal. Local examination revealed a pulsatile swelling on the right temporal-occipital region of the scalp. Few dilated veins were noted in this region. On auscultation, a bruit was detected over the lesion. Other systemic examination was normal, including thyroid, breast, and musculoskeletal system.

Patient underwent computed tomography of the brain along with angiography. Aneurysmal dilated mass of vessels were detected in the right temporal-occipital region of scalp in the subcutaneous plane [Figure 1], which enhanced markedly. Feeding vessel was from the occipital artery posteriorly and the superficial temporal artery [Figure 2]. Large draining veins were noted running anteriorly and posterior to the occiput [Figure 3]. A diagnosis of cirsoid aneurysm of scalp was made. Patient was advised to undergo excision of the aneurysm, but the patient refused surgery. She was discharged with an advice of regular follow-up.

Unenhanced axial CT image shows a serpiginous subcutaneous mass in the right temporal-occipital region
Figure 1
Unenhanced axial CT image shows a serpiginous subcutaneous mass in the right temporal-occipital region
Contrast-enhanced axial CT image shows marked contrast enhancement within the cirsoid aneurysm
Figure 2
Contrast-enhanced axial CT image shows marked contrast enhancement within the cirsoid aneurysm
CT angiogram showing the lesion
Figure 3
CT angiogram showing the lesion

Cirsoid aneurysms of the scalp were first described in 1833 by Brecht.[1] Cirsoid aneurysms are rare arterio-venous fistulas of the scalp. They are usually congenital in etiology. However, traumatic fistulas have also been described.[1] In 90% of the patients, the superficial temporal artery is the main supply to the fistula with only one dominant feeding artery in 71% of patients.[2] In the remaining cases, there is usually involvement of both the superficial temporal and occipital arteries.[12] Untreated patients can develop progressive scalp and facial cosmetic deformity from the markedly tortuous subcutaneous vessels. However, this condition is not life-threatening.[2] Surgical resection of the fistula is usually successful. Endovascular and percutaneous occlusion of the fistulas have been described. However, the results have been mixed.

Differential diagnosis of a pulsatile scalp swelling includes the following: superficial temporal artery aneurysm although rare should be considered when a temporal region mass is evaluated. This condition is almost always a result of blunt or penetrating head trauma. Clinical examination with imaging confirms the diagnosis. Simple elective ligation and excision of the aneurysm are curative.[3]

A-V malformations may be congenital or traumatic in origin. Clinical manifestation may include a loud continuous bruit, hemorrhage and throbbing headache, and in severe cases scalp necrosis. Angiography is the investigation of choice. Primary lesions can be excised completely without significant blood loss and scalp necrosis.[4] Metastatic deposits from follicular carcinoma of thyroid have to be ruled out prior to the diagnosis of cirsoid aneurysm.

Source of Support: Nil.

Conflict of Interest: None declared.

References

  1. , , , , . Surgical management of cirsoid aneurysms. Acta Neurochir (Wien). 2002;144:349-56.
    [Google Scholar]
  2. , , , , . Cirsoid aneurysms of the scalp. Neurosurg Rev. 2006;29:208-12.
    [Google Scholar]
  3. , , , . Aneurysm of the superficial temporal artery. Neurosurgery. 1988;23:499-500.
    [Google Scholar]
  4. , , . Scalp arteriovenous malformations. Neurol India. 2004;52:478-81.
    [Google Scholar]

    Fulltext Views
    1,352

    PDF downloads
    446
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections