Absolute Ethanol Embolization Combined with Surgical Resection of Scalp Arteriovenous Malformations: Interim Results

To assess treatment methods, interim results, and complications of absolute ethanol embolization combined with surgical resection of scalp arteriovenous malformations (AVMs).

From September 2012 to January 2015, 15 consecutive patients (8 male and 7 female) with scalp AVMs underwent staged ethanol embolizations. Ethanol embolization was performed using transcatheter and/or direct puncture techniques. Ten patients with scalp AVMs with a dominant outflow vein (DOV) also underwent coil deployment before ethanol embolization. Two patients underwent surgical resection after ethanol embolization was achieved. Follow-up evaluations included clinical outcome of symptoms and signs and imaging at 1.5 months, 6 months, and annually thereafter.

In 15 patients, 33 ethanol embolizations were performed; 16 coil deployments were performed in 10 patients who had scalp AVMs with a DOV. Of 15 patients, 8 (53.3%) were cured, 2 of whom underwent surgical resection. All 8 patients showed no recurrence in the follow-up period (range, 12-48 months; mean, 25 months). Seven patients (46.7%) had partial remission and will need further treatment sessions for residual AVMs (range, 1-12 months; mean, 7 months). In 3 of 15 patients (20%), 7 minor complications (skin blisters and necrosis) occurred. All minor complications healed with wound dressing and observation. There were no major complications.

Ethanol embolization has the potential for cure in management of scalp AVMs, with an acceptable risk of minor and major complications. Once AVMs are devascularized, surgical resection can be performed to improve cosmetic results.