Epicranial Arteriovenous Fistula: A Case Series and Review of the Literature

Epicranial arteriovenous fistulas (EAVFs) refer to vascular malformations located in the soft tissues of the scalp. They have a low incidence, and their cause can be traumatic, iatrogenic, or spontaneous. The arterial supply frequently originates from the superficial temporal artery and its branches. EAVFs present as a pulsating mass, with local pain and thrill, and sometimes occur as spontaneous bleeding. Six-vessel angiography is the gold standard for diagnosis, but AngioCT is also useful. The treatment options include surgery, embolization, or a combination of both. The decision for treatment should be made depending on the hemodynamics of the fistula. In this case series, we discuss four cases of EAVF: one male and three females, with a mean age of 37.8 years. Two of the fistulas were fed by the superficial temporal artery, one case by the occipital artery, and one case by both. Two cases required surgery and embolization, while two cases were treated with surgery alone. EAVFs are atypical events, and an appropriate understanding of their affluency, drainage, and hemodynamic features is required to decide the proper course of their management.