{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T21:16:43Z","timestamp":1768598203839,"version":"3.49.0"},"reference-count":16,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Cirsoid aneurysms are rare, high-flow arteriovenous malformations (AVMs) of the scalp and neck, formed by direct arteriovenous shunts without an intervening capillary bed. They may present with pulsatile swelling, bruit, cosmetic disfigurement, pain, or hemorrhage. Giant, diffuse lesions with feeders from multiple vascular territories are uncommon and pose significant therapeutic challenges.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n \n A 24-year-old male presented with a 10\u201312-year history of an enlarging occipital mass, which had rapidly increased in size over the preceding 2\u20133 years. Examination revealed a pulsatile, warm lesion extending anteriorly to the neck (right > left) with overlying skin thinning and discoloration; a loud bruit was audible. Computed tomography angiography demonstrated a 24 \u00d7 22 cm high-flow AVM supplied by multiple feeders from the external carotid and vertebral arteries, with venous drainage into the right internal jugular vein. Preoperative super-selective embolization was performed to reduce vascularity, followed by\n en bloc<\/jats:italic>\n surgical resection along the pericranial plane with ligation of all feeders. Reconstruction was achieved using a split-thickness skin graft harvested from the thigh. The initial recovery was uneventful, with complete graft uptake. At 3 months, recurrence secondary to neoangiogenesis was treated with repeat embolization and adjuvant external beam radiotherapy. At the latest follow-up, the graft remained healthy, with no further bleeding or lesion progression.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Giant scalp and neck cirsoid aneurysms require meticulous preoperative imaging, staged endovascular flow reduction, complete surgical excision, and coordinated multidisciplinary management. Recurrence from collateral vessel formation may occur despite optimal therapy, underscoring the importance of long-term clinical and radiological surveillance.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_1143_2025","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T09:06:23Z","timestamp":1768554383000},"page":"23","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A giant challenge: Hybrid management of a scalp and neck cirsoid aneurysm"],"prefix":"10.25259","volume":"17","author":[{"given":"Viraj","family":"Narola","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anmol Anant","family":"Dobriyal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul Rajendrakumar","family":"Rana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anmol Singh","family":"Randhawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jitendra Singh","family":"Verma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anurag","family":"Srivastava","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhawani Shanker","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pankaj","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohin","family":"Bhatia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer","family":"Narad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Foram","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandharbh","family":"Gautam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vartika","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"10.25259\/SNI_1143_2025\/ref-1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.5469\/neuroint.2023.00171","article-title":"Management of adult unruptured brain arteriovenous malformations: An Updated network meta-analysis","volume":"18","author":"Dmytriw","year":"2023","journal-title":"Neurointervention"},{"key":"10.25259\/SNI_1143_2025\/ref-2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4103\/1793-5482.106651","article-title":"Results of surgical excision of cirsoid aneurysm of the scalp without preoperative interventions","volume":"7","author":"El Shazly","year":"2012","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_1143_2025\/ref-3","doi-asserted-by":"crossref","first-page":"e756","DOI":"10.1016\/j.wneu.2021.03.140","article-title":"Surgical management of cirsoid aneurysms of the scalp: Ten years\u2019 experience","volume":"150","author":"ElKiran","year":"2021","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_1143_2025\/ref-4","doi-asserted-by":"crossref","first-page":"437","DOI":"10.3171\/2012.10.JNS121280","article-title":"Natural history of cerebral arteriovenous malformations: A meta-analysis","volume":"118","author":"Gross","year":"2013","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_1143_2025\/ref-5","doi-asserted-by":"crossref","first-page":"e889","DOI":"10.1016\/j.wneu.2021.11.091","article-title":"Upfront and repeated gamma-knife radiosurgery for small (\u22645 mL) unruptured brain arteriovenous malformation: A cohort of 249 consecutive patients","volume":"158","author":"Hak","year":"2022","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_1143_2025\/ref-6","doi-asserted-by":"crossref","first-page":"1461341","DOI":"10.3389\/fneur.2024.1461341","article-title":"Retrospective clinical study on the efficacy and complications of interventional embolization in the treatment of scalp arteriovenous fistula","volume":"15","author":"Han","year":"2024","journal-title":"Front Neurol"},{"key":"10.25259\/SNI_1143_2025\/ref-7","doi-asserted-by":"crossref","first-page":"296","DOI":"10.3171\/jns.1990.73.2.0296","article-title":"Elimination of a cirsoid aneurysm of the scalp by direct percutaneous embolization with thrombogenic coils. 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