Cirsoid Aneurysm: Report of Two Cases With Cosmetic Surgical Treatment and Narrative Review of the Literature

Cirsoid aneurysm (CA) is a rare high-flow arteriovenous malformation (AVM) of the scalp that may cause cosmetic deformity, neurologic symptoms, skin ulceration, or hemorrhage. We report two men with left frontoparietal lesions supplied by the frontal branch of the superficial temporal artery. A 37-year-old man presented with a progressively enlarging pulsatile mass of 3 years' duration. Duplex ultrasonography and computed tomography angiography (CTA) demonstrated a high-flow scalp AVM with extensive venous drainage and no intracranial communication. A 27-year-old man presented with a 1-year history of a pulsatile mass that underwent rapid enlargement, ulceration, and massive bleeding. Temporary hemostasis was achieved by compression, and CTA showed a similar lesion without intracranial communication. Both patients underwent complete surgical excision through a left coronal incision without preoperative embolization. The feeding artery was ligated, the abnormal venous network was resected, and the ulcerated skin was excised in the second patient. Neither procedure required transfusion, and both postoperative courses were uneventful. At clinical follow-up of 6 months in the first patient and 3 months in the second, facial muscle function was preserved, cosmetic outcomes were satisfactory, and no clinical recurrence was detected. These cases support surgical excision as an effective option for localized, surgically accessible CAs with a limited arterial supply, while treatment should be individualized according to lesion extent, vascular anatomy, symptoms, hemorrhagic risk, and cosmetic objectives.