J Korean Soc Radiol.  2011 Sep;65(3):229-233.

Direct Puncture Embolization of Scalp Arteriovenous Malformation in a Patient with Severe Hemophilia A: A Case Report

• Lee KM
• Kim EJ
• Park BJ
• Kim KH

Abstract

We present a case of scalp arteriovenous malformation (AVM) in a patient with severe hemophilia A. The 22-year-old man presented with a pulsatile right parietal scalp mass. Digital subtraction angiography revealed an AVM in the right parietal scalp, supplied by superficial temporal and occipital arteries that drained into multiple venous structures. We successfully performed direct puncture embolization followed by surgical resection of the scalp AVM in conjunction with supplemental infusion of coagulation factor VIII before, during and after the embolization and the operation.

MeSH Terms

Angiography, Digital Subtraction
Arteries
Arteriovenous Malformations
Factor VIII
Hemophilia A
Humans
Punctures
Scalp
Young Adult
Factor VIII

Figure

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  Fig. 1 Contrast enhanced CT reveals prominent vessels with an aneurysmal sac on the subcutaneous layer of the right parietal scalp.

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  Fig. 2 Lateral projection images from right (A) and left (B) ECA angiography show opacification of an AVM of the right parietal scalp. The lesion was supplied by dilated superficial temporal and occipital arteries and were drained into multiple early dilated venous structures. Note.-AVM = arteriovenous malformation, ECA = external cerebral artery

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  Fig. 3 A. Lateral projection from the direct puncture angiography shows filling of the lesion with contrast material and the venous drainage. B. Lateral projection after insertion of detachable coils (Nester and Tornado coils) shows multiple coils filling the aneurysmal sac and vascular structures.

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  Fig. 4 Lateral radiograph obtained after another direct puncture of the nidus was obtained with manual compression during injection NBCA with lipiodol. Note.-NBCA = n-butyl-cyanoacrylate

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  Fig. 5 Lateral projection images from the right ECA angiography after embolization show effective devascularization of the lesion. Note.-ECA = external cerebral artery

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