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PubMed1996

Spline Laplacian estimate of EEG potentials over a realistic magnetic resonance-constructed scalp surface model.

This paper presents a realistic Laplacian (RL) estimator based on a tensorial formulation of the surface Laplacian (SL) that uses the 2-D thin plate spline function to obtain a mathematical description of a realistic scalp surface. Because of this tensorial formulation, the RL does not need an orthogonal reference frame placed on the realistic scalp surface. In simulation experiments the RL was estimated with an increasing number of "electrodes" (up to 256) on a mathematical scalp model, the analytic Laplacian being used as a reference. Second and third order spherical spline Laplacian estimates were examined for comparison. Noise of increasing magnitude and spatial frequency was added to the simulated potential distributions. Movement-related potentials and somatosensory evoked potentials sampled with 128 electrodes were used to estimate the RL on a realistically shaped, MR-constructed model of the subject's scalp surface. The RL was also estimated on a mathematical spherical scalp model computed from the real scalp surface. Simulation experiments showed that the performances of the RL estimator were similar to those of the second and third order spherical spline Laplacians. Furthermore, the information content of scalp-recorded potentials was clearly better when the RL estimator computed the SL of the potential on an MR-constructed scalp surface model.

Brain Mapping↗
PubMed2004

A multicentre study to determine the efficacy and patient acceptability of the Paxman Scalp Cooler to prevent hair loss in patients receiving chemotherapy.

Alopecia is a distressing and common side-effect of chemotherapy, especially anthracycline- and taxane-containing regimen. A series of studies and reviews have considered scalp cooling as a means of reducing this side-effect without a definitive result. The aim of the study was to determine the efficacy and patient acceptability of scalp cooling using the Paxman Scalp Cooler. This was an open, non-randomised, observational study conducted at eight sites involving 94 patients. Alopecia was assessed using the World Health Organisation (WHO) grading system. Patient acceptability was assessed by questionnaire. Results were compiled by Scalp Cooling Assessment Groups using data from eight centres in the UK collected between 1997 and 2000. Use of the Paxman Scalp Cooler was adjudged a success for 89% of all patients using the WHO grading system for alopecia and for 87% of patients being specifically administered the commonly used 5-fluorouracil, epirubicin and cyclophosphamide (FEC) regimen. When asked about degrees of comfort during the scalp-cooling process, 85% of patients described it as very comfortable, reasonably comfortable or comfortable, with only 15% of patients reporting a description of uncomfortable or very uncomfortable. Scalp cooling using the Paxman Scalp Cooler was found to be an effective technique with minimal side-effects for patients treated with commonly prescribed alopecia-inducing chemotherapy drugs.

Adult↗
PubMed1997

An overview of age-related changes in the scalp distribution of P3b.

In this overview of 7 studies, the scalp distribution of the P3b component (i.e. the P3 or P300) of the event-related potential elicited by target events in young and older adults was assessed. The target P3b data were recorded in either auditory oddball paradigms or in visual study tasks in which orienting activity was manipulated (as a within-subjects variable) in investigations of indirect memory. Some of the studies required choice reaction time responses, whereas others required responses only to the target stimuli. Motor response requirements had a profound effect on the P3b scalp distribution of older but not of younger subjects. The presence of a frontally oriented scalp focus in the topographies of the older adults in most of the tasks described here is consistent with older adults continuing to use prefrontal processes for stimuli that should have already been well encoded and/or categorized. However, although older subjects generally had different P3b scalp distributions than younger subjects, their scalp distributions were modulated similarly by task requirements. These data suggest that similar mechanisms modulate the scalp distribution of P3b in older compared to younger adults. However, in the older adult, these scalp distribution changes in response to task demands are superimposed on a frontally oriented scalp focus due to a putative frontal lobe contribution to target P3b topography.

Adult↗
PubMed2004

The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women.

BACKGROUND: Chronic diffuse telogen hair loss is common in women. Paired 4-mm punch biopsy from the vertex scalp for horizontal and vertical sectioning is commonly used to distinguish between chronic telogen effluvium (CTE) and female pattern hair loss (FPHL). FPHL is now the favored term for androgenetic alopecia in women. OBJECTIVE AND METHODS: To evaluate the reliability of a single horizontally sectioned scalp biopsy in the diagnosis of FPHL, 207 women presenting with chronic diffuse hair loss had three 4-mm punch biopsy specimens taken from immediately adjacent skin on the mid scalp, and all 3 biopsy specimens were sectioned horizontally. Findings were compared with 305 women who underwent two biopsies, with one sectioned horizontally and the other vertically. The terminal to vellus-like hair ratio (T:V) at the mid-isthmus level was used to diagnose FPHL (T:V <4:1), CTE (T:V >8:1), or indeterminate hair loss (T:V=5:1, 6:1, or 7:1). To correlate the histologic diagnosis with the clinical severity, a mid-scalp clinical grading scale was developed. RESULTS: Among the 305 women who had a single horizontal scalp biopsy, 181 (59%) were diagnosed as having FPHL, 54 (18%) having CTE, and 70 (23%) having indeterminate hair loss. Six hundred twenty-one horizontal biopsy specimens were assessed from 207 patients. On the basis of consensus over 3 biopsies, 159 (77%) were diagnosed as having FPHL, 44 (21%) having CTE, and the remaining 4 women (2%) as having indeterminate hair loss. Among these 207 women, 114 were assessed clinically as having stage 1 or 2 hair loss. Sixty-nine (60%) were diagnosed as having FPHL on the basis of triple biopsy, 42 (37%) having CTE, and 2 having indeterminate hair loss. Ninety-three were graded as having stage 3, 4, or 5 hair loss. FPHL was diagnosed in 90 women (97%), CTE in 2, and indeterminate hair loss in one. By using each single biopsy as the criterion for diagnosis, 398 (61%) were classified as FPHL, 99 (16%) as CTE, and 124 (20%) as indeterminate. In 493 biopsies (79%), the single biopsy conclusion was identical to the 3 biopsy conclusions. Where disagreement was seen (21%), most were classified as indeterminate, rather than as a wrong diagnosis (3.3%). CONCLUSION: Application of these diagnostic criteria achieved accurate diagnostic definition in 98% of women with triple horizontal biopsies versus 79% with single horizontal biopsy. Ninety-seven percent of women with a mid-scalp clinical grade of 3, 4, or 5 were given a diagnosis of FPHL on triple biopsy. Scalp biopsy for diagnosis should be reserved for women with a mid-scalp clinical grade of 1 or 2.

Adolescent↗
PubMed1999

Rectal-scalp temperature difference predicts brain death in children.

When brain death in children occurs, commonly the scalp feels cold despite a normal core temperature. This phenomenon might reflect absent cerebral blood flow and metabolic activity. The authors, therefore, measured rectal-scalp temperature differences in critically ill comatose children to test the hypothesis that a particular temperature difference may correlate with clinical brain death. In a prospective cohort study set in a pediatric intensive care unit, rectal-scalp, rectal-abdomen, and rectal-mastoid temperatures in critically ill comatose children older than 18 months of age were measured before and during brain death evaluations. Twelve children were enrolled. Clinical criteria for brain death were met by seven patients, and five patients survived. All of the seven children who died had rectal-scalp temperature differences greater than 4 degrees C (mean = 6.7, range = 6.0-7.4) at the time of clinical brain death. No survivor had a rectal-scalp temperature difference of 4 degrees C at any time (mean = 3.4, range = 2.9-3.9). Rectal-scalp temperature differences of those who died and those who survived were significantly different at the P < 0.005 level. Rectal-abdomen and rectal-mastoid temperature differences did not correlate with clinical brain death or rectal-scalp temperature difference. In this preliminary study a rectal-scalp temperature difference of greater than 4 degrees C correlates with clinical criteria for brain death in children.

Biomarkers↗
PubMed2002

Distinct fronto-central N60 and supra-sylvian N70 middle-latency components of the median nerve SEPs as assessed by scalp topographic analysis, dipolar source modelling and depth recordings.

OBJECTIVES: To investigate the possible contribution of the second somatosensory (SII) area in the generation of the N60 somatosensory evoked potential (SEP). METHODS: In 7 epileptic patients and in 6 healthy subjects scalp SEPs were recorded by 19 electrodes placed according to the 10-20 system. All epileptic patients but one were also investigated using depth electrodes chronically implanted in the parieto-rolandic opercular cortex. Scalp SEPs underwent brain electrical source analysis. RESULTS: In both epileptic patients and healthy subjects, scalp recordings showed two middle-latency components clearly distinguishable on the basis of latency and scalp distribution: a fronto-central N60 potential contralateral to stimulation and a later bilateral temporal N70 response. SEP dipolar source modelling showed that a contralateral perisylvian dipole was activated in the scalp N70 latency range whereas separate perirolandic and frontal sources were activated at the scalp N60 latency. Depth electrodes recorded a biphasic N60/P90 response in the parieto-rolandic opercular regions contra- and ipsilateral to stimulation. CONCLUSIONS: Two different middle-latency SEP components N60 and N70 can be distinguished by topographic analysis and source modelling of scalp recordings, the sources of which are located in the fronto-central cortex contralateral to stimulation and in the supra-sylvian cortex on both sides, respectively. The source location of the scalp N70 in the SII area is strongly supported by its spatio-temporal similarities with SEPs directly recorded in the supra-sylvian opercular cortex.

Adult↗
PubMed2000

Double-blind clinical study reveals synergistic action between alpha-hydroxy acid and betamethasone lotions towards topical treatment of scalp psoriasis.

OBJECTIVE: A double-blind, single-site, split-face clinical study was organized and carried out in order to evaluate the efficacy, tolerability, and safety of a glycolic acid containing scalp lotion in conjunction with a betamethasone (as the 17-valerate) scalp application against conditions of psoriasis. BACKGROUND: Alpha-hydroxy acids (AHA) have been proposed as therapeutic modalities against skin exfoliative conditions such as ichthyosis, xeroderma, and psoriasis. AHAs are hereby clinically investigated as therapeutic modalities adjuvant to corticosteroids in order to diminish systemic and topical adverse side-effects most frequently associated with use of the latter. METHODS: Twenty patients suffering from scalp psoriasis and other psoriatic conditions were included in a double-blind, split-face clinical study, using combinations of a 10% (w/w) glycolic acid scalp lotion, placebo lotion (excipients only), and a 0.1% (w/w) betamethasone scalp application, applied twice daily without any bandage for a period of 8 weeks. Clinical assessments were carried out by highly experienced physician evaluations based on a four-grade scale, prior to treatment and after 2, 4, 6 and 8 weeks. RESULTS: Improvement was observed in all cases included in the study following treatment with the 10% glycolic acid lotion. However, when equal parts of the 0.1% betamethasone lotion were combined, most of the treated sites were healed. Moreover, the duration of treatment required for healing was in this case reduced to approximately half of that needed when the glycolic acid or the betamethasone lotions were used separately for treatment. CONCLUSIONS: The present clinical study demonstrates for the first time that the effective and well tolerated therapeutic efficacy of glycolic acid scalp lotions is enhanced when used in conjunction with a 0.1% betamethasone scalp application against scalp psoriasis. This potential offers the practising dermatologist with novel treatment modes against severe skin conditions by combining topical corticosteroid with exfoliative agent therapy.

Administration, Topical↗
PubMed2002

Surgical anatomy of the scalp.

BACKGROUND: The goal of complication-free scalp surgery remains elusive. Wide unsightly scars, stretch-atrophied hypesthetic, poorly vascularized tissues and distorted hair patterns are still commonly seen and appear to be largely refractory to remedial surgery. OBJECTIVE: To establish technical guidelines for scalp surgery most compatible with maximum functional/cosmetic benefit and complication-free results. METHODS: More than 3000 scalp operations, done personally, were reviewed. These covered the entire spectrum of plastic and reconstructive surgery and hair restoration procedures including more than 700 clinical surgical investigative procedures with pericranial flaps, subgaleal and subperiosteal scalp reductions, and deep plane fixation procedures. RESULTS: Notably improved scalp surgery outcomes resulted from the application of data derived from study of the surgical anatomy of the scalp. Unsightly scars, distorted hair patterns, hypesthetic poorly vascularized tissues, and distorted hair patterns were largely avoided. CONCLUSION: An understanding of the surgical anatomy of the scalp is a cornerstone on which complication-free scalp surgery is based.

Biomechanical Phenomena↗
PubMed1992

Identification and selective inhibition of an isozyme of steroid 5 alpha-reductase in human scalp.

Steroid 5 alpha-reductase (EC 1.3.1.22) catalyzes the reduction of testosterone to dihydrotestosterone. The 5 alpha-reductase found in human scalp has been compared with the enzyme found in prostate. The scalp reductase has a broad pH optimum centered at pH 7.0. This is distinctly different from the pH optimum of 5.5 observed with the prostatic form of the enzyme. These enzymes also differ in the Km for testosterone, which is 25-fold higher for the scalp reductase. The most significant difference between the two enzymes is their affinity for inhibitors. Two 4-azasteroids and a 3-carboxyandrostadiene are potent inhibitors of the prostatic reductase but are weak inhibitors of the scalp reductase. In contrast, several N-4-methylazasteroids are good inhibitors of the scalp reductase. These findings support a proposal that different isozymes of 5 alpha-reductase may exist in scalp and prostate. The scalp reductase was also compared to 5 alpha-reductase 1, one of the two enzymes recently cloned from human prostate [Andersson, S. & Russell, D. W. (1990) Proc. Natl. Acad. Sci. USA 87, 3640-3644; and Andersson, S., Berman, D. M., Jenkins, E. P. & Russell, D. W. (1991) Nature (London) 354, 159-161]. The characteristics of the cloned reductase 1 are comparable to those of the scalp reductase.

Animals↗
PubMed1999

Outcome of scalp donor sites in 450 consecutive pediatric burn patients.

The scalp is a useful and reliable donor site in pediatric burn patients that can be multiply harvested with minimal morbidity. Healing complications, however, may include alopecia and chronic folliculitis. To investigate scalp donor-site morbidity, a consecutive series of 2478 pediatric burn patients treated over a 10-year period were reviewed. A total of 450 of these patients had scalp donor sites for wound closure. Percent of total body surface area burned was 46+/-23 percent (mean+/-standard deviation), and the mean number of sequential scalp donor-site harvests was 2.2+/-2 (range, 1 to 10) with mean intervals between harvesting of 6+/-0.6 days. Ten patients (2.2 percent) had related complications. Eight patients developed scalp folliculitis, with Staphylococcus sp as the predominant organism (80 percent). Two patients were managed successfully with wound care alone; the other six patients required surgical debridement and split-thickness skin grafting to achieve wound healing. These eight patients developed varying degrees of alopecia. Two patients developed alopecia without previous folliculitis. Six patients required reconstructive surgery, which consisted of primary closure (3), staged excision (1), and tissue expansion (2). A number of variables were examined to determine any differences in the group that had complications compared with the group of patients that did not. No differences in age, sex, race, burn type, burn size, septic episodes, time to wound closure, or number of times the scalp was harvested were detected. Healed second-degree burns to the scalp that were subsequently taken as donor sites seemed to be a risk factor (p < 0.05) for folliculitis and alopecia. Our study confirms that scalp donor sites are reliable with low morbidity. Complications include alopecia and chronic folliculitis that can be avoided by meticulous technique and avoidance of previously burned areas.

Alopecia↗
PubMed1999

Ineffectiveness of acute scalp expansion.

The aim of this study was to test the ex vivo biomechanical properties of acutely expanded scalp flaps to quantitatively assess the efficacy of acute scalp expansion. A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (4 x 10 cm), laterally based flap was designed on each side of the scalp, starting from the superior margin of the external auditory canal. One randomly selected flap per scalp underwent acute intermittent expansion (a 3-minute expansion/3-minute rest cycle was performed three times with the maximum expansion achievable); the contralateral flap served as a control. After the expansion process, the acutely expanded flaps were measured to assess whether applied biomechanical stress caused any changes in flap dimensions. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force transducer. The obtained data showed that the biomechanical benefits provided by acute scalp expansion were not statistically different (p < 0.05) from those obtained by simple subgaleal undermining. No change of length nor gain in compliance was observed in the acutely expanded flaps as compared with control scalp flaps. In the authors' opinion, a possible explanation (to be further validated) for the lack of effect of acute scalp expansion might be that the inelastic galea aponeurotica did not allow mechanical creep to exploit the inherent elastic properties of the overlying scalp skin.

Adult↗
PubMed1992

A randomized controlled trial to compare three types of fetal scalp electrode.

OBJECTIVES: To compare three scalp electrodes in respect of need for reapplication, trace quality and scalp trauma. DESIGN: Randomized controlled trial. SETTING: Maternity Unit, Royal Berkshire Hospital, Reading. PARTICIPANTS: 780 women in labour at term, with cephalic fetal presentation, deemed to require electronic fetal heart rate monitoring using a scalp electrode. INTERVENTIONS: Three types of fetal scalp electrode: Rocket-Rolon (double-helix spiral); Hewlett-Packard (double-helix spiral); and Surgicraft-Copeland (clip). MAIN OUTCOME MEASURES: Need for more than one electrode; reason for replacement; trace quality; scalp trauma; direct financial costs. RESULTS: Reapplication was significantly least likely in the Surgicraft-Copeland group (odds ratio vs Hewlett-Packard = 0.61, 95% CI 0.41-0.90; odds ratio vs Rocket-Rolon = 0.43, 95% CI = 0.29-0.62). This reflected a much lower rate of replacement because of detachment. The Hewlett-Packard was, however, least likely to be replaced because of poor trace quality. Interpretable traces were equally common, but trace quality tended to be superior in the Hewlett-Packard group. There was no serious scalp trauma. Difficulty removing the electrode was least often reported in the Hewlett-Packard group, and a mark on the scalp persisted least often in the Rocket-Rolon group. CONCLUSIONS: The Surgicraft-Copeland performed the best overall, and particularly in respect of attachment to the scalp. It appears to be the electrode of choice of the three tested.

Adult↗
PubMed1996

Anchor scalp reduction.

BACKGROUND: Unsightly scars, stretch-back, and stretch atrophy are common complications of scalp reduction. OBJECTIVE: To remove as much bald scalp as possible while preserving normal tissue integrity (e.g., thickness, vascularity) and cosmesis. METHODS: Surgical innovations anchor scalp reduction I & II, use pericranial flaps as aids to facilitate maximal reduction while limiting postoperative distraction vector forces responsible for stretch-back, stretch-atrophy, and wide scars. RESULTS: Anchor scalp reduction I consistently results in fine barely perceptible scars. Anchor scalp reduction II enables maximal bald area reduction while minimizing the incidence of stretch-back and wide scars. CONCLUSIONS: Anchor scalp reduction I is a simple innovation recommended for suturing scalp incisions where the primary objective is a fine barely discernible scar, e.g., in plastic surgery or neurosurgery. Anchor scalp reduction II is preferred for hair restoration procedures where the primary objective is maximizing reduction while minimizing stretch-back and stretch atrophy.

Alopecia↗
PubMed2005

Intracranial EEG substrates of scalp EEG interictal spikes.

PURPOSE: To determine the area of cortical generators of scalp EEG interictal spikes, such as those in the temporal lobe epilepsy. METHODS: We recorded simultaneously 26 channels of scalp EEG with subtemporal supplementary electrodes and 46 to 98 channels of intracranial EEG in 16 surgery candidates with temporal lobe epilepsy. Cerebral discharges with and without scalp EEG correlates were identified, and the area of cortical sources was estimated from the number of electrode contacts demonstrating concurrent depolarization. RESULTS: We reviewed approximately 600 interictal spikes recorded with intracranial EEG. Only a very few of these cortical spikes were associated with scalp recognizable potentials; 90% of cortical spikes with a source area of >10 cm(2) produced scalp EEG spikes, whereas only 10% of cortical spikes having <10 cm(2) of source area produced scalp potentials. Intracranial spikes with <6 cm(2) of area were never associated with scalp EEG spikes. CONCLUSIONS: Cerebral sources of scalp EEG spikes are larger than commonly thought. Synchronous or at least temporally overlapping activation of 10-20 cm(2) of gyral cortex is common. The attenuating property of the skull may actually serve a useful role in filtering out all but the most significant interictal discharges that can recruit substantial surrounding cortex.

Brain Mapping↗
PubMed1986

Red blood cell flow in the fetal scalp during hypoxemia in the chronic sheep experiment: a laser Doppler flow study.

Reliable monitoring of arterial blood gas values in the fetal scalp microcirculation requires an unimpaired local skin blood flow. Previous studies have shown that in the fetus blood flow to "nonvital" organs and tissues is reduced during hypoxemia. However, data on fetal scalp blood flow during hypoxemia have not been reported. Therefore, the influence of hypoxemia on scalp blood flow was studied in four chronically catheterized fetal lambs of 125-135 days of gestation. Red blood cell flow in the fetal scalp was continuously measured by the laser Doppler method during nine experiments. Reducing the oxygen saturation of fetal carotid arterial blood from an average control value of 52 to 21% for 20 min resulted in an average decrease of the laser Doppler flow index of 7%. In vitro studies revealed that more than half of the observed decrease in laser Doppler flow index could be attributed to enhanced absorption of light from the HeNe-laser caused by the deoxygenation of oxyhemoglobin itself. In the first 20 min after hypoxia, fetal scalp blood flow remained below the prehypoxic value. It is concluded that moderate hypoxemia causes only a small decrease in fetal scalp blood flow, certainly when compared to the dramatic fall in scalp blood flow that has been observed when local or circular pressure is exerted onto the fetal scalp.

Animals↗
PubMed1994

The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness.

The effects of the 5 alpha-reductase inhibitor, finasteride, on scalp skin testosterone (T) and dihydrotestosterone (DHT) levels were studied in patients with male pattern baldness. In a double blind study, male patients undergoing hair transplantation were treated with oral finasteride (5 mg/day) or placebo for 28 days. Scalp skin biopsies were obtained before and after treatment for measurement of T and DHT by high pressure liquid chromatography-RIA. In 10 male subjects studied at baseline, mean (+/- SEM) DHT levels were significantly higher in bald (7.37 +/- 1.24 pmol/g) compared to hair-containing (4.20 +/- 0.65 pmol/g) scalp, whereas there was no difference in mean T levels at baseline. In bald scalp from 8 patients treated with finasteride, the mean DHT concentration decreased from 6.40 +/- 1.07 pmol/g at baseline to 3.62 +/- 0.38 pmol/g on day 28. Scalp T levels increased in 6 of 8 subjects treated with finasteride. Finasteride decreased the mean serum DHT concentration from 1.36 +/- 0.18 nmol/L (n = 8) at baseline to 0.46 +/- 0.10 nmol/L on day 28 and had no effect on serum T. There were no significant changes in scalp or serum T or DHT in placebo-treated patients. In this study, male subjects treated with 5 mg/day finasteride for 4 weeks had significantly decreased concentrations of DHT in bald scalp, resulting in a mean level similar to the baseline levels found in hair-containing scalp.

5-alpha Reductase Inhibitors↗
PubMed2000

[Intraoperative expansion of scalp flaps. Quantitative assessment].

BACKGROUND: The aim of this study was to test the ex-vivo biomechanical properties of acutely expanded scalp flaps, in order to quantitatively assess the efficacy of acute scalp expansion. METHODS: A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (4 x 10 cm), laterally-based flap was designed on each side of the scalp, starting from the superior margin of the external auditory canal. One randomly-selected flap per each scalp underwent acute-intermittent expansion (3-minute expansion-3-minute rest cycle per three times with the maximal expansion achievable), while the contralateral flap served as control. After the expansion process, the acutely-expanded flaps were measured to assess if the applied biomechanical stress have determined any changes in their dimensions. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force-transducer. RESULTS: The obtained data showed that the biomechanical benefits provided by acute scalp expansion were not statistically different (p < 0.05) from those obtained by simple subgaleal undermining. Neither any change of length nor any gain in the compliance have been observed in the acutely-expanded flaps as compared to control scalp flaps. CONCLUSIONS: In our opinion, a possible explanation (to be further validated) for the lack of effect of acute scalp expansion might be that inelastic galea aponeurotica did not allow the mechanical creep to exploit the inherent elastic properties of the overlying scalp skin.

Adult↗
PubMed2004

Scalp arteriovenous malformations.

AIMS: We discuss our experience with the surgical management of scalp vascular malformation and review the literature on the subject. SETTINGS AND DESIGN: A prospective case-control study of eight patients with scalp vascular malformations admitted to our hospital between 1997 and 2002. METHODS AND MATERIALS: All the patients were investigated with selective internal and external carotid angiography. Depending upon the origin of feeding arteries, the scalp vascular malformations were classified into two categories: Group I: the primary scalp arteriovenous malformations and Group II: secondary venous dilatations. Six patients belonged to Group I and two patients were in Group II. RESULTS: Five patients belonging to Group I underwent successful excision of the arteriovenous malformation. There was no recurrence in this group. Of the two patients in Group II, one patient who had scalp vascular dilatation simulating a primary scalp vascular malformation underwent excision of the lesion. This patient developed severe postoperative brain edema and died. CONCLUSIONS: Primary scalp vascular malformation can be excised safely. However, excision of secondary scalp venous dilatation without treatment of the intracranial component can be dangerous.

Adult↗