Cervicofacial vascular lesions are very challenging to manage and require a MDT. Angiography is the gold standard method of imaging as it offers a detailed assessment of the vascular anatomy, and mostly, treatment can be done at the same sitting. Till now, there is no universally accepted choice of management as these lesions are difficult to treat and have high rates of morbidity and recurrence. Interventional radiology can be used effectively to control them through embolization. Most of these vascular lesions require surgery after embolization as JNAs and large AVMs, yet few lesions are totally cured as in cases of small AVMs .
Thanks to the significant rapid change in the practice of interventional radiology, in many cases, less invasive techniques such as CTA have replaced DSA as the initial tool in the diagnosis, management planning, and follow-up of treated patients .
Mazora et al.  described AVM in two-dimensional (2D) CTA as a brightly enhancing lesion. On 3D images, it appears as a tangle of disorganized vessels rather than the discrete mass appearance of the hemangiomas. Related feeding or draining vessels were abnormally disorganized, prominent, and tortuous. Same findings were described in this study at 2D and 3D images.
The sensitivity of CTA in the diagnosis of vascular disease was 98.4%, specificity was 99.4%, false positive was 1.1%, and false negative was 0.9%. Meifang et al.  revealed that CTA examination showed high specificity and sensitivity and low rate of misdiagnosis, with no significant difference with DSA which was observed in most of our cases offering the advantage of non-invasive procedure.
Pedreira et al.  revealed no significant difference in recurrence rates in patients receiving immediate (1 day) or delayed (10.6 days) resection after embolization by a 5-year follow-up interval. In this study, surgical resection was done during the first 72 h after embolization with a 12.5% recurrence rate only after a 3-year follow-up interval, as it was the most acceptable time interval for surgeons for a less bloody operation.
Lesion size was a significant predictor for lesion recurrence, with all lesions > 6 cm in any dimension recurring and none of the lesions < 6 cm recurring. This is matching with the analysis from Kohout et al.  which assumed that smaller lesions resected are most likely to remain in remission while those that are symptomatic and larger are difficult to treat and liable for recurrence. This assumption is nearly matching with these study results as large (> 7 cm) lesions were more liable to recur after embolization in contrast to smaller (< 7 cm) lesions.
With ethanol embolization alone, mostly for cervicofacial AVMs, Do et al.  have reported a 68% success rate (cure and improvement).
In the current study, we did not use the ethanol as an embolic agent so we cannot judge its effectiveness.
Histoacryl (Glue) was the main embolizing agent in this study in cases of AVM including cirsoid aneurysms via trans-arterial approach as onyx was not easily available as well as its cost is high.
Amran et al.  demonstrated that the internal maxillary artery (IMA), a branch of the external carotid artery, is the main feeding artery for the JNA.
Routine catheterization of common and external carotid arteries bilaterally was done as 80% of our cases had bilateral feeders. The commonest feeders were the IMA and ascending pharyngeal artery.
Li et al.  retrospectively reviewed 21 patients, 11 of whom received preoperative embolization, and compared them with 10 patients who did not get embolized. There was a significant difference in surgical blood loss and need for blood transfusions, favoring the embolization group, and there were no complications from embolization.
Preoperative JNA embolization was very effective in the cases of this study as their surgeons admitted significant decrease in blood loss and operation time as well as amount of packed RBCs needed for transfusion especially in large lesions.
Economopoulos et al.  successfully performed preoperative embolization via PVA particles (150–300 μm) and gelfoam in 10 of 11 patients with large carotid body tumors, achieving adequate tumor devascularization. Medium-sized PVA particles (300–500 μm) was our material of choice in JNA embolization (with/without gelfoam) which achieved good vessel penetration reaching the nidus with subsequent complete occlusion.
Alawneh et al.  mentioned the most frequent sites of involvement in scalp AVMs were the frontal, temporal, and parietal regions. The origin of the main feeder is in the subcutaneous tissue of the scalp which originates from the ECA where the superficial temporal artery is most frequently involved one.
At this study, we faced two cases of scalp AVMs with history of trauma (cirsoid aneurysms) which were at the parietal and frontal regions. They were supplied by the superficial temporal artery and effectively embolized by histoacryl followed by resection.
There were few limitations at this study such as the high cost of the used materials in embolization procedures, refusal of few patients to embolization after explaining the possible complications that could happen, and finally the small number of patients diagnosed with these lesions who were seeking for medical advice.