Abstract：
To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report.
A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study.
A total of 49 articles (91 patients) were included. The patients\' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months.
The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.
A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study.
A total of 49 articles (91 patients) were included. The patients\' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months.
The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.
摘要：
目的：评估术前血管内栓塞（EE）和手术切除（SE）联合方法治疗头皮动静脉畸形（AVM）的疗效，并提供说明性病例报告。
方法：使用在线数据库进行了系统评价(PubMed/Medline，科克伦,和Embase）于2023年2月15日。纳入标准是对头皮AVM患者进行的任何类型的研究，这些患者通过血管造影进行诊断和确认，并接受术前EE和SE的联合治疗。所有符合纳入标准的文章均纳入本研究。
结果：共纳入49篇文献（91例患者）。患者在就诊时的年龄范围为10天至70岁。最常见的症状是搏动性肿块51例（56.04%），31例患者的肿块逐渐增加（34.06%），22例患者出现瘀伤和/或惊厥（24.17%）。术前EE和SE并发症仅在5例患者中观察到；3例患者（3.29％）收获了植皮边缘坏死，1例(1.09%)皮肤坏死,1例(1.09%)伤口感染。在12个月的中位随访期内，只有两名患者（2.19％）报告了复发或残留的肿块。
结论：头皮AVM的管理可能具有挑战性；因此，专注,并且需要准确识别血管解剖结构的复杂性。术前EE和SE联合治疗的结果令人满意，并发症和复发率低；因此，我们推荐这种方法用于头皮AVM的管理。
方法：使用在线数据库进行了系统评价(PubMed/Medline，科克伦,和Embase）于2023年2月15日。纳入标准是对头皮AVM患者进行的任何类型的研究，这些患者通过血管造影进行诊断和确认，并接受术前EE和SE的联合治疗。所有符合纳入标准的文章均纳入本研究。
结果：共纳入49篇文献（91例患者）。患者在就诊时的年龄范围为10天至70岁。最常见的症状是搏动性肿块51例（56.04%），31例患者的肿块逐渐增加（34.06%），22例患者出现瘀伤和/或惊厥（24.17%）。术前EE和SE并发症仅在5例患者中观察到；3例患者（3.29％）收获了植皮边缘坏死，1例(1.09%)皮肤坏死,1例(1.09%)伤口感染。在12个月的中位随访期内，只有两名患者（2.19％）报告了复发或残留的肿块。
结论：头皮AVM的管理可能具有挑战性；因此，专注,并且需要准确识别血管解剖结构的复杂性。术前EE和SE联合治疗的结果令人满意，并发症和复发率低；因此，我们推荐这种方法用于头皮AVM的管理。
