Anomalous fistulous arteriovenous communications of scalp (cirsoid aneurysms) are infrequent occurrences of vascular origin with ill-defined natural course. Arteriovenous malformations (AVM) of the scalp presenting clinically at times with headache and a small innocuous looking subcutaneous scalp lump or a large, pulsatile mass with or without bruit which has a propensity to massive haemorrhage. These vascular lesions when present over scalp are seen mostly on the frontoparietal and temporal regions. Complex vascular anatomy and interconnections, high shunt flow and possible cosmetic complications tend to make their management difficult. We report a rare case of high shunt flow scalp AVM of occipital region that progressively enlarged over the course of 6 years by capturing feeders from bilateral occipital arteries. Being high flow shunt surgical excision was attempted.
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