Treatment of a Giant Scalp Arteriovenous Fistula in a Child

OBJECTIVE: To evaluate the feasibility and safety of direct surgical excision for a giant scalp arteriovenous fistula (sAVF) in a child, and to provide a reference for optimizing treatment strategies for pediatric sAVF. METHODS: A retrospective analysis was conducted of a pediatric case of giant sAVF (Yokouchi type C/Yu grade 4). The lesion measured ~14 cm × 12 cm × 4 cm and involved the right frontal, temporal, and parietal regions. It was supplied by bilateral superficial temporal arteries and drained via the right superficial temporal vein. After a multidisciplinary team (MDT) assessment, the patient underwent direct surgical resection without preoperative embolization. Early intraoperative occlusion of the feeding arteries was employed to control hemorrhage. The patient was followed up for 12 months postoperatively. RESULTS: The lesion was completely excised. No postoperative complications such as infection or scalp necrosis occurred, and the incision achieved primary healing. At the 12-month follow-up, there was no evidence of recurrence; the patient had a satisfactory cosmetic outcome and a good quality of life. CONCLUSIONS: For pediatric giant sAVFs with superficial feeding arteries that can be controlled early intraoperatively, lesions located on the convex surface of the scalp, and no intracranial vascular supply, direct surgical excision is a safe, effective, and curative one-stage treatment option.