Surgical management of scalp arteriovenous malformations using anovel surgical technique

Scalp clip is a rare condition. Although surgical excision is considered as definitive treatment for these lesions, troublesome intraoperative bleeding may pose a challenge. Proximal feeding artery temporary clipping has been utilized by the authors in this series to address troublesome intraoperative bleeding. The authors present their experience in the surgical management of using proximal feeding artery temporary occlusion followed by total surgical excision. The clinical presentations and radiological features of these cases are discussed in the article. Intra operative blood loss was less than 150 ml in all patients. Postoperative period was uneventful with no mortality. Intraoperative bleeding during surgical excision of scalp clip can be troublesome and challenging. As the surgery done is a standard well established procedure, no separate ethical approval was necessary. All the three surgeries were done. Patients were placed in supine position with head elevated 30◦above heart level. Scalp flap was devised depending on the anatomy of the nidus & the direction of feeding vessels. In a case of left temporal SAVM a separate vertical incision was put on left side of neck to expose ECA for proximal control. In two patients, superficial temporal artery was exposed and temporary clip applied for reducing vascularity of the lesion. The scalp flap was raised along with pericranium. Dissection was done in plane. The feeding arteries were identified along their course at base of scalp was temporarily clipped with clamp.