• Agbolahan Sofela, Temidayo Osunronbi, and Samantha Hettige.
• Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.
• Neurosurgery. 2020 Feb 1; 86 (2): E98-E107.

BackgroundScalp cirsoid aneurysms are rare subcutaneous arteriovenous fistulae affecting the scalp. They can be easily misdiagnosed and mistreated.ObjectiveTo review reported cases of scalp cirsoid aneurysms for their incidence, etiology, clinical presentation, treatment, and outcomes using an illustrative case.MethodsWe conducted a PUBMED, SCOPUS, OVID SP, SciELO, and INFORMA search using the keywords; "cirsoid," "aneurysm," "arteriovenous," "malformation," "scalp," "vascular," and "fistula." We identified 74 pertinent papers, reporting 242 cases in addition to our reported index case.ResultsMedian age at presentation was 25 yr (range 1-72 yr); male to female ratio was 2.5:1. The most common symptoms were a pulsatile mass (94% of patients), headaches (25%), and tinnitus (20%). The median duration of symptoms was 3 yr (6 d to 31 yr), with 60.2% occurring spontaneously, 32.23% traumatic, and the rest iatrogenic. A total of 58.5% of cases were managed with surgical excision only, 21.6% with endovascular embolization only, and 14.5% with a combination of both methods. The complication rate observed in the endovascular embolization treatment cohort (55.8%) was significantly higher than that observed in the surgical excision only cohort (9.9%) (P < .00001) and in the combined therapy cohort (0%) (P < .00001). There is a low recurrence rate after treatment irrespective of modality: surgical excision only (6.3%), endovascular embolization only (8.3%), and combined therapy (0%).ConclusionScalp cirsoid aneurysms are associated with good prognoses when recognized and managed appropriately. We suggest combining surgery with endovascular embolization as the optimum treatment modality.Copyright © 2019 by the Congress of Neurological Surgeons.

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