{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:12:53Z","timestamp":1769724773621,"version":"3.49.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"17","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,10,27]]},"abstract":"\n BACKGROUND<\/jats:title>\n Cirsoid aneurysms are rare arteriovenous fistulas involving direct connections between scalp arteries and draining veins, often located within the periosteal or temporal fascia, or beneath the galea. First described by Brecht in 1833, these lesions may be congenital or posttraumatic and can occasionally be associated with intracranial vascular malformations.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 69-year-old woman with thrombocytopenia developed a large cirsoid aneurysm in the right parieto-occipital subcutaneous region following head trauma. The lesion evolved into a soft tissue hematoma, eventually leading to a spontaneous cutaneous fistula with active, profuse bleeding. An endovascular embolization attempt failed due to complex vascular architecture. Emergency surgical intervention was performed for hematoma evacuation and complete resection of the vascular malformation.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case is unique in combining several high-risk factors rarely reported together: an acutely ruptured cirsoid aneurysm, severe thrombocytopenia, and failed endovascular embolization due to prohibitive vessel tortuosity. A successful outcome was achieved through rapid multidisciplinary coordination\u2014integrating neurosurgical expertise for definitive nidus excision, hematological optimization, and reconstructive planning to preserve scalp integrity.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25508<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25508","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:06:01Z","timestamp":1762214761000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical management of a ruptured cirsoid aneurysm: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Danilo","family":"De Paulis","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital of the Sea, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Catapano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of the Sea, Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hambra","family":"Di Vitantonio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, San Salvatore City Hospital, L\u2019Aquila, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabino","family":"Luzzi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Gallieni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, San Salvatore City Hospital, L\u2019Aquila, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soheila Raysi","family":"Dehcordi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, San Salvatore City Hospital, L\u2019Aquila, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Ricci","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, San Salvatore City Hospital, L\u2019Aquila, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1933-1355","authenticated-orcid":true,"given":"Renato J.","family":"Galzio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Arch Anat Physiol","first-page":"208","article-title":"\u00dcber Aneurysma Cirsoides","author":"Brecht","year":"1833","unstructured":"Brecht A.\u00dcber Aneurysma Cirsoides. Arch Anat Physiol. 1833:208-212."},{"key":"bib2","series-title":"Discourses on the Nature and Cure of Wounds","author":"Bell","year":"1795","unstructured":"Bell J.Discourses on the Nature and Cure of Wounds. Bell & Bradfute; 1795."},{"issue":"1","key":"bib3","series-title":"J Neurosurg","first-page":"56","article-title":"Arteriovenous malformations of the scalp: treatment using interventional neuroradiological techniques","volume":"77","author":"Halbach","year":"1992","unstructured":"Halbach VVHigashida RTHieshima GBHardin CWDowd CF.Arteriovenous malformations of the scalp: treatment using interventional neuroradiological techniques. J Neurosurg. 1992;77(1):56-59."},{"issue":"1","key":"bib4","series-title":"J Neurosurg","first-page":"179","article-title":"Cirsoid aneurysms of the scalp: diagnosis and management","volume":"121","author":"Ngu","year":"2014","unstructured":"Ngu JSrivastava VBalasubramanian DBhattacharya J.Cirsoid aneurysms of the scalp: diagnosis and management. J Neurosurg. 2014;121(1):179-186."},{"issue":"3","key":"bib5","series-title":"Neurosurgery","first-page":"327","article-title":"Cirsoid aneurysms of the scalp","volume":"14","author":"Miller","year":"1984","unstructured":"Miller NRPessin MSDebrun GMCirsoid aneurysms of the scalp. Neurosurgery. 1984;14(3):327-332."},{"issue":"7","key":"bib6","series-title":"Neuroradiology","first-page":"537","article-title":"Use of MRA in the diagnosis of scalp AVMs","volume":"36","author":"Raps","year":"1994","unstructured":"Raps ECHurst RWHuckman MSFlamm ES.Use of MRA in the diagnosis of scalp AVMs. Neuroradiology. 1994;36(7):537-540."},{"issue":"1","key":"bib7","series-title":"Neurol India","first-page":"61","article-title":"Posttraumatic scalp arteriovenous malformations","volume":"48","author":"Bhargava","year":"2000","unstructured":"Bhargava PHegde ASBhatjiwale MGoel A.Posttraumatic scalp arteriovenous malformations. Neurol India. 2000;48(1):61-63."},{"issue":"4","key":"bib8","series-title":"Neuroradiology","first-page":"317","article-title":"Endovascular treatment of scalp AVMs","volume":"50","author":"Gupta","year":"2008","unstructured":"Gupta VParthasarathy RJena AChoudhary A.Endovascular treatment of scalp AVMs. Neuroradiology. 2008;50(4):317-322."},{"issue":"2","key":"bib9","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Endovascular and surgical treatment of scalp AVMs","volume":"18","author":"Kim","year":"2005","unstructured":"Kim LJAlbuquerque FCMcDougall CGZabramski JMSpetzler RF.Endovascular and surgical treatment of scalp AVMs. Neurosurg Focus. 2005;18(2):E9."},{"issue":"6","key":"bib10","series-title":"Neurosurgery","first-page":"969","article-title":"Management of scalp arteriovenous malformations","volume":"33","author":"Tyagi","year":"1993","unstructured":"Tyagi DKSawhney IMBanerji AK.Management of scalp arteriovenous malformations. Neurosurgery. 1993;33(6):969-974."},{"issue":"2","key":"bib11","series-title":"Neurosurgery","first-page":"E98","article-title":"Scalp cirsoid aneurysms: case illustration and systematic review of literature","volume":"86","author":"Sofela","year":"2020","unstructured":"Sofela AOsunronbi THettige S.Scalp cirsoid aneurysms: case illustration and systematic review of literature. Neurosurgery. 2020;86(2):E98-E107."},{"issue":"4","key":"bib12","series-title":"J Neurosurg Case Lessons","first-page":"CASE23551","article-title":"A large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case","volume":"7","author":"Pahari","year":"2024","unstructured":"Pahari SBhandari PBBhattarai BA large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case. 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World Neurosurg. 2021;155:e600-e604."},{"issue":"3","key":"bib15","series-title":"Br J Neurosurg","first-page":"371","article-title":"Management of scalp arteriovenous malformation: case series and review of literature","volume":"26","author":"Kumar","year":"2012","unstructured":"Kumar RSharma GSharma BS.Management of scalp arteriovenous malformation: case series and review of literature. Br J Neurosurg. 2012;26(3):371-377."},{"issue":"4","key":"bib16","series-title":"Radiol Bras","first-page":"224","article-title":"Endovascular treatment of scalp cirsoid aneurysms","volume":"43","author":"Wajnberg","year":"2010","unstructured":"Wajnberg E.Endovascular treatment of scalp cirsoid aneurysms. Radiol Bras. 2010;43(4):224-228."},{"key":"bib17","series-title":"World Neurosurg","first-page":"692","article-title":"Transvenous endovascular treatment for scalp arteriovenous fistulas: results with combined use of onyx and coils","volume":"107","author":"Ni","year":"2017","unstructured":"Ni WTian YGu YMao Y.Transvenous endovascular treatment for scalp arteriovenous fistulas: results with combined use of onyx and coils. World Neurosurg. 2017;107:692-697."},{"key":"bib18","series-title":"World Neurosurg","first-page":"416","article-title":"Scalp cirsoid aneurysm: an updated systematic literature review and an illustrative case report","volume":"119","author":"Albuquerque Sousa","year":"2018","unstructured":"Albuquerque Sousa LHMaranha Gatto LADemartini Junior ZKoppe GL.Scalp cirsoid aneurysm: an updated systematic literature review and an illustrative case report. 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Asian J Neurosurg. 2012;7(4):191-196."},{"issue":"1","key":"bib20","series-title":"Trials","first-page":"592","article-title":"The TREATT Trial (TRial to EvaluAte tranexamic acid therapy in thrombocytopenia): safety and efficacy of tranexamic acid in patients with haematological malignancies with severe thrombocytopenia: study protocol for a doubleblind randomised controlled trial","volume":"20","author":"Estcourt","year":"2019","unstructured":"Estcourt LJMcQuilten ZPowter GThe TREATT Trial (TRial to EvaluAte tranexamic acid therapy in thrombocytopenia): safety and efficacy of tranexamic acid in patients with haematological malignancies with severe thrombocytopenia: study protocol for a doubleblind randomised controlled trial. Trials. 2019;20(1):592."},{"key":"bib21","series-title":"Surg Neurol Int","first-page":"117","article-title":"Cortical aneurysms of the middle cerebral artery: a review of the literature","volume":"8","author":"Ricci","year":"2017","unstructured":"Ricci ADi Vitantonio HDe Paulis DCortical aneurysms of the middle cerebral artery: a review of the literature. Surg Neurol Int. 2017;8:117."},{"key":"bib1","series-title":"Arch Anat Physiol","first-page":"208","article-title":"\u00dcber Aneurysma Cirsoides","author":"Brecht","year":"1833","unstructured":"Brecht A.\u00dcber Aneurysma Cirsoides. Arch Anat Physiol. 1833:208-212."},{"key":"bib2","series-title":"Discourses on the Nature and Cure of Wounds","author":"Bell","year":"1795","unstructured":"Bell J.Discourses on the Nature and Cure of Wounds. Bell & Bradfute; 1795."},{"issue":"1","key":"bib3","series-title":"J Neurosurg","first-page":"56","article-title":"Arteriovenous malformations of the scalp: treatment using interventional neuroradiological techniques","volume":"77","author":"Halbach","year":"1992","unstructured":"Halbach VVHigashida RTHieshima GBHardin CWDowd CF.Arteriovenous malformations of the scalp: treatment using interventional neuroradiological techniques. J Neurosurg. 1992;77(1):56-59."},{"issue":"1","key":"bib4","series-title":"J Neurosurg","first-page":"179","article-title":"Cirsoid aneurysms of the scalp: diagnosis and management","volume":"121","author":"Ngu","year":"2014","unstructured":"Ngu JSrivastava VBalasubramanian DBhattacharya J.Cirsoid aneurysms of the scalp: diagnosis and management. J Neurosurg. 2014;121(1):179-186."},{"issue":"3","key":"bib5","series-title":"Neurosurgery","first-page":"327","article-title":"Cirsoid aneurysms of the scalp","volume":"14","author":"Miller","year":"1984","unstructured":"Miller NRPessin MSDebrun GMCirsoid aneurysms of the scalp. Neurosurgery. 1984;14(3):327-332."},{"issue":"7","key":"bib6","series-title":"Neuroradiology","first-page":"537","article-title":"Use of MRA in the diagnosis of scalp AVMs","volume":"36","author":"Raps","year":"1994","unstructured":"Raps ECHurst RWHuckman MSFlamm ES.Use of MRA in the diagnosis of scalp AVMs. Neuroradiology. 1994;36(7):537-540."},{"issue":"1","key":"bib7","series-title":"Neurol India","first-page":"61","article-title":"Posttraumatic scalp arteriovenous malformations","volume":"48","author":"Bhargava","year":"2000","unstructured":"Bhargava PHegde ASBhatjiwale MGoel A.Posttraumatic scalp arteriovenous malformations. Neurol India. 2000;48(1):61-63."},{"issue":"4","key":"bib8","series-title":"Neuroradiology","first-page":"317","article-title":"Endovascular treatment of scalp AVMs","volume":"50","author":"Gupta","year":"2008","unstructured":"Gupta VParthasarathy RJena AChoudhary A.Endovascular treatment of scalp AVMs. Neuroradiology. 2008;50(4):317-322."},{"issue":"2","key":"bib9","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Endovascular and surgical treatment of scalp AVMs","volume":"18","author":"Kim","year":"2005","unstructured":"Kim LJAlbuquerque FCMcDougall CGZabramski JMSpetzler RF.Endovascular and surgical treatment of scalp AVMs. Neurosurg Focus. 2005;18(2):E9."},{"issue":"6","key":"bib10","series-title":"Neurosurgery","first-page":"969","article-title":"Management of scalp arteriovenous malformations","volume":"33","author":"Tyagi","year":"1993","unstructured":"Tyagi DKSawhney IMBanerji AK.Management of scalp arteriovenous malformations. Neurosurgery. 1993;33(6):969-974."},{"issue":"2","key":"bib11","series-title":"Neurosurgery","first-page":"E98","article-title":"Scalp cirsoid aneurysms: case illustration and systematic review of literature","volume":"86","author":"Sofela","year":"2020","unstructured":"Sofela AOsunronbi THettige S.Scalp cirsoid aneurysms: case illustration and systematic review of literature. Neurosurgery. 2020;86(2):E98-E107."},{"issue":"4","key":"bib12","series-title":"J Neurosurg Case Lessons","first-page":"CASE23551","article-title":"A large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case","volume":"7","author":"Pahari","year":"2024","unstructured":"Pahari SBhandari PBBhattarai BA large cirsoid aneurysm of the scalp with multiple arterial supply: illustrative case. J Neurosurg Case Lessons. 2024;7(4):CASE23551."},{"key":"bib13","series-title":"Clin Neurol Neurosurg","first-page":"106437","article-title":"Contemporary management of scalp cirsoid aneurysm: a dual-trained neurosurgeon\u2019s perspective","volume":"201","author":"Furtado","year":"2021","unstructured":"Furtado SVSrinivasa RVala KMohan D.Contemporary management of scalp cirsoid aneurysm: a dual-trained neurosurgeon\u2019s perspective. Clin Neurol Neurosurg. 2021;201:106437."},{"key":"bib14","series-title":"World Neurosurg","first-page":"e600","article-title":"Surgical excision of cirsoid aneurysm of the scalp: case series and review of the literature","volume":"155","author":"Karki","year":"2021","unstructured":"Karki MRoka YB.Surgical excision of cirsoid aneurysm of the scalp: case series and review of the literature. 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