BACKGROUND: Cirsoid aneurysms are uncommon arteriovenous fistulas of the scalp. 
Surgery for these lesions can be difficult; transarterial embolization is rarely 
curative, while embolization of the venous pouch with permanent agents usually 
necessitates subsequent surgical removal of the embolic material. The ideal 
embolic agent would be one that is safe and effective, commercially available, 
and would not require subsequent removal.
METHODS: We treated an arteriovenous fistula of the scalp with direct puncture 
and injection of sodium tetradecyl sulfate, a commercially available sclerosing 
agent.
RESULTS: Control angiography immediately following percutaneous injection of 
sotradecol into the fistula showed decreased flow but not complete closure of 
the lesion. However, within several days of the embolization, the patient's 
scalp pain and mass resolved. Four months after embolization, MRA demonstrated 
no evidence of residual or recurrent fistula. Color doppler flow imaging 
demonstrated only slightly decreased vascular resistance in the distal 
superficial temporal artery, possibly indirect evidence of persistent 
micro-fistulae. Twenty-three months after the procedure, the patient continued 
to be asymptomatic and had no palpable lesion.
CONCLUSIONS: Percutaneous injection of sotradecol can be considered as one of 
the treatment options for arteriovenous fistula of the scalp. Further experience 
is needed to compare the safety and effectiveness of sotradecol with other 
agents currently used in the treatment of scalp arteriovenous fistulae.