can thiệp nội mạch kết hợp phẫu thuận điều trị dị dạng thông động tĩnh mạch dưới da đầu phức tạp: Báo cáo trường hợp lâm sàng tại bệnh viện Việt Đức

Preoperative endovascular embolisation for treatment of complicated scalp arteriovenous malformations: a case report from viet duc university hospital

SUMMARY

Introduction: Scalp arteriovenous malformations (sAVMs) are rare and complex vascular lesions, thought to be present at birth and characterized by variable growth leading to disfiguring and life-threatening complications. Of all vascular malformations, AVMs can be the most dangerous and difficult to manage because of their high flow, bleeding risk, and infiltrative nature. Treatment of these lesions is until a major challenge, especially for diffuse lesions, requires expert multimodal and multi-disciplinary care.

Clinical case: A 12 - year - old girl, detected and partially treated for a scalp AVM of left parietal, came to the hospital because of severe bleeding from rupture sAVM. On CTA and DSA demonstrated a diffuse scalp AVM located in the parietal region, supplied from many branches of bilateral internal maxillary arteries, middle meningeal arteries, superficial temporal arteries, occipital arteries anterior cerebral artery (ACA), drainage to superior sagittal sinus. The sAVM’s feeders were catheterized and totally embolized by combine through transfemoral artery, transfemoral vein, and direct percutaneous approach. Surgical resection the nidus was performed 4 days after.

Conclusion: The complex scalp AVM lesions are always major challenges in treatment. Endovascular embolization plays an important role in reducing complications and increasing the ability to completely remove lesions.

Keywords: Scalp arteriovenous malformations, endovascular embolization.