A case of hemorrhagic non traumatic arteriovenous fistula of the scalp

Arteriovenous malformation of the scalp in an uncommon disease and treatment for this lesion is difficult and controversial. A twenty-three-year-old male, who reported no history of head trauma, presented with spontaneous hemorrhage from the left temporal scalp. Neurologically he was normal except the tinnitus. Left external carotid angiography demonstrated arteriovenous malformation fed by the superior temporal and posterior auricular arteries. A dilated tortuous occipital artery was also recognized. The lesions were able to be surgically resected, alleviating intraoperative massive hemorrhage by proximal temporary occlusion of the external carotid artery at the left neck. Small feeding arteries from the meningeal artery which were not recognized on preoperative angiography were found at surgery. The arteriovenous fistula was successfully resected without any cosmetic problem.