This video describes the novel approach to removing an arteriovenous malformation (AVM) of the forehead using an endoscopic technique in a trichial incision. A 17-year-old presented to the Otolaryngology clinic with facial pain and headaches, as well as a pulsatile mass on her forehead. Angiography was performed and proved the mass to be an AVM. Angiography also revealed that one of the feeders was coming directly off the ophthalmic artery. She had no other neurological or ophthalmological symptoms. However, because of the ophthalmic artery feeder, embolization could not be performed due to the risk of blindness.
We made an incision in the hairline, down to the subgaleal plane, and the entirety of the mass was revealed. Using endoscopy for visualization, the feeder vessels were carefully tied off using a knot pusher and ligated. The vessels were then cut and the mass removed. The skin was closed and a pressure dressing placed.
At her post-operative visits, the patient was very pleased with the cosmetic outcomes of the surgery. Of note, there was no facial numbness, facial nerve weakness, or vision changes. We will continue to monitor the child, but as of yet there has been no evidence of recurrence of her AVM.