PMC10244559_01
Time-of-flight magnetic resonance angiography revealed a prominent blood supply via the right external carotid artery. Photo courtesy of Thekla von Kalle, Institute for Pediatric Radiology, Olgahospital, Klinikum Stuttgart.
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F1
A repeat MRI study revealed that the highly vascular lesion was supplied primarily by the right external carotid artery (Figure 1).
A fusiform incision was followed by outward dissection until the cranium was reached.
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F2
To preserve skin for primary closure, the lesion was dissected outwards until the cranium was reached (Figure 2).
The endothelial cell shows expression of CD31, CD34 and D2-40. GLUT-1 is absent in the immunohistochemistry imaging.
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F3
A histopathological evaluation confirmed the diagnosis of CH based on glucose transporter (GLUT)-1 negativity (Figure 3).
PMC10244559_02
Angiographic outcomes after TAE (A,B) and PS (C). TAE performed using Magic Glue (Balt)/Lipiodol  (Guerbet) on the right external carotid artery resulted in significant reductions in the arterial blood supply to the lesion. PS with Glubranis 2/Lipiodol  and Magic Glue/Lipiodol  administered locally was performed to eliminate the remaining vessels of the extensive blood supply to this lesion.
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F4
Percutaneous sclerotherapy (PS) with Glubran 2/Lipiodol  and Magic Glue/Lipiodol  in a 1:2 ratio was used to ablate the extensive blood supply to this lesion (Figure 4).
Extensive cauterization of the small vessels supplying the lesion during the surgical intervention. The skin was held by multiple sutures to facilitate easy acess to the lesion.
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F5
Despite the previous embolization procedures, the patient sustained substantial blood loss from the smaller feeder vessels (Figure 5); a blood transfusion was ultimately required.