Endoscopic Resection of Forehead Arteriovenous Malformation

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.

This is a novel approach to removing an arteriovenous malformation of the forehead using an endoscopic technique via a trichial incision in order to provide the most optimal cosmetic result and complete resection of the mass.
Pulsatile arteriovenous malformation on forehead.
Poor visualization or approach options via endoscopy. Size of arteriovenous malformation (AVM). Location of AVM.
Approach from the head of the bed, monitor at the foot of the bed in order to allow for visualization into the wound and at the endoscopy video.
The length and location of the trichial incision is dependent on the location and extent needed to access the AVM.
Aesthetic outcome is optimized by avoiding a direct incision over the AVM
Risk of bleeding and need to control vessels if one is injured poses risk of needing to convert to a direct approach to the mass.

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