case_images: PMC10244559_01
case_images: Time-of-flight magnetic resonance angiography revealed a prominent blood supply via the right external carotid artery. Photo courtesy of Thekla von Kalle, Institute for Pediatric Radiology, Olgahospital, Klinikum Stuttgart.
case_images: fsurg-10-1045285-g001.jpg
case_images: PMC10244559_01_fsurg-10-1045285-g001.jpg
case_images: F1
case_images: A repeat MRI study revealed that the highly vascular lesion was supplied primarily by the right external carotid artery (Figure 1).
case_images: A fusiform incision was followed by outward dissection until the cranium was reached.
case_images: fsurg-10-1045285-g002.jpg
case_images: PMC10244559_01_fsurg-10-1045285-g002.jpg
case_images: F2
case_images: To preserve skin for primary closure, the lesion was dissected outwards until the cranium was reached (Figure 2).
case_images: The endothelial cell shows expression of CD31, CD34 and D2-40. GLUT-1 is absent in the immunohistochemistry imaging.
case_images: fsurg-10-1045285-g003.jpg
case_images: PMC10244559_01_fsurg-10-1045285-g003.jpg
case_images: F3
case_images: A histopathological evaluation confirmed the diagnosis of CH based on glucose transporter (GLUT)-1 negativity (Figure 3).
case_images: PMC10244559_02
case_images: Angiographic outcomes after TAE (A,B) and PS (C). TAE performed using Magic Glue (Balt)/Lipiodol  (Guerbet) on the right external carotid artery resulted in significant reductions in the arterial blood supply to the lesion. PS with Glubranis 2/Lipiodol  and Magic Glue/Lipiodol  administered locally was performed to eliminate the remaining vessels of the extensive blood supply to this lesion.
case_images: fsurg-10-1045285-g004.jpg
case_images: PMC10244559_02_fsurg-10-1045285-g004.jpg
case_images: F4
case_images: Percutaneous sclerotherapy (PS) with Glubran 2/Lipiodol  and Magic Glue/Lipiodol  in a 1:2 ratio was used to ablate the extensive blood supply to this lesion (Figure 4).
case_images: Extensive cauterization of the small vessels supplying the lesion during the surgical intervention. The skin was held by multiple sutures to facilitate easy acess to the lesion.
case_images: fsurg-10-1045285-g005.jpg
case_images: PMC10244559_02_fsurg-10-1045285-g005.jpg
case_images: F5
case_images: Despite the previous embolization procedures, the patient sustained substantial blood loss from the smaller feeder vessels (Figure 5); a blood transfusion was ultimately required.