Treatment of a scalp arteriovenous malformation by a combination of embolization and surgical removal.

SUMMARY: The authors describe a 21-year-old man in whom a large arteriovenous malformation of the scalp was eliminated using a combined interventional, neuroradiological and neurosurgical approach. Embolization was utilized to reduce arterial blood supply to the malformation. Eudragit- E, as a liquid embolic material from a cationic polymer, methyl and butyl methacrylate, and dimethylaminoethyl methacrylate copolymer, was injected through the transarterial route and then by direct percutaneous puncture of the nidus. One week after embolization, the nidus was easily resected with minimal blood loss. A postoperative angiogram showed nearly total extirpation of the nidus as well as complete clinical recovery. Preoperative embolization in this case was a safe and effective ablative technique.