头皮动静脉畸形,也被称为环状动脉瘤,是直接连通的动脉和静脉的复杂集合。随着环形动脉瘤的生长,它可以从多个颅内和颅外血管中吸收血液供应,并累及头皮和面部组织。根据它们的大小和复杂性,可以使用各种策略来治疗它们。
我们介绍了一个巨大的环形动脉瘤血管内栓塞治疗,切除,使用多个扩张的头皮和面部皮瓣进行重建。一个15岁的男孩出现了一个脉动的左颞叶头皮肿块,该肿块缓慢生长,累及了他的大部分左头皮,并延伸到同侧面部。在他的下一次演讲中,19岁时,他最近出现了偶发性横向视野丧失,畏光,头痛,和眩晕.导管血管造影显示广泛的动静脉畸形,主要由左颞浅表提供,耳后,和枕骨动脉,以及眼动脉,血管造影还显示硬脑膜动静脉瘘。最初,将组织扩张器放置在顶点,枕骨,和左下面部区域。然后病人接受了血管内栓塞术,然后使用多个扩张的头皮和面部皮瓣切除和重建组织缺损。患者恢复良好,无神经功能缺损,症状完全缓解。我们的手术合作使他的发际线和面部对称性得到了整体保留。
大型环状动脉瘤需要多学科结合栓塞治疗,切除,以及闭合组织缺损的整形外科技术。
Scalp arteriovenous malformations, also known as cirsoid aneurysms, are complex collections of directly communicating arteries and veins. As a cirsoid aneurysm grows, it can recruit a blood supply from multiple intracranial and extracranial vessels and involve both scalp and facial tissue. Depending on their size and complexity, a variety of strategies can be used to treat them.
We have presented the case of a giant cirsoid aneurysm treated with endovascular embolization, resection, and reconstruction using multiple expanded scalp and facial flaps. A 15-year-old boy had presented with a pulsatile left temporal scalp mass that had slowly grown to involve most of his left scalp and extend into the ipsilateral face. At his next presentation, at 19 years old, he had recently developed episodic lateral visual field loss, photophobia, headaches, and vertigo. Catheter angiography demonstrated an extensive arteriovenous malformation supplied primarily by the left superficial temporal, posterior auricular, and occipital arteries, as well as by the ophthalmic artery, The angiogram also showed a dural arteriovenous fistula. Initially, tissue expanders were placed in the vertex, occipital, and left lower facial regions. The patient then underwent endovascular embolization, followed by resection and reconstruction of the tissue defect using multiple expanded scalp and facial flaps. The patient recovered well without neurological deficits and had complete resolution of his symptoms. Our surgical collaboration resulted in overall preservation of his hairline and facial symmetry.
Large cirsoid aneurysms can require multidisciplinary treatment combining embolization, resection, and plastic surgical techniques to close the tissue defects.