We present the clinical case of a 50-year-old female, professionally oriented and discredited funambulist, with no personal history of violence, who progressively developed, in a 10-year-old front position, with an irregular head mass.
In the anamnesis, the patient remembers a traumatic history for 12 years, with frontal contusion, after which she suffered an important bifrontal subgaleal hematoma, which was resolved conservatively in the course of approximately two months.
Apart from this incident, she does not report other symptoms and the physical and neurological examination is normal.
Traumatic arteriovenous fistula is suspected.
Brain MRI showed no significant alterations and cerebral angiography of the territories of the internal and external carotid artery showed a temporal epicraneal vascular nest in the left frontal artery, with extracraneal and superficial circulation of both cerebral arteries.
Embolization of the branches arising from the intracranial contributions was not performed due to the high risk of amaurosis of one or both eyes, nor of the extracranial ones, as it was considered possible by surgical resection.
A bicoronal incision was made behind the nest, bilaterally adhering to the branches of the AVM, to first attach them and sectify them, and thus reduce the blood supply to a controlled lesion
The nest was outside the pericranium and under the cellular tissue, and showed irrigation through the subcutaneous arch from the intracranial branches that showed the previous angiography.
Radiofrequency coagulation, both mono and bipolar, and bone wax were used to control bleeding.
All subcutaneous blood vessels were resected, and only in some isolated and specific areas hair follicles were evident.
During the surgery, it was necessary to transfuse with two units of concentrates; additionally, a blood recuperator (ORTHOPAT HAEMOICS) was required for better control of blood loss.
The scalp was sutured in the usual manner by planes and the skin was sutured with graphs.
There were no neurological complications during the postoperative period and the wound healed adequately, without developing areas of necrosis or alopecia.
The cosmetic result was excellent.
After one year he has not shown recurrence.
