This study reviewed the surgical management of cirsoid aneurysms of the scalp, which are rarely encountered in the neurosurgical practice, and compares the results with embolization. 21 patients with cirsoid aneurysm underwent surgery. There were 1 female and 20 male patients. Trauma was present in four patients. Selective internal and external carotid artery angiograms and cranial magnetic resonance imaging studies were performed on all patients. All angiograms were staged according to published procedures. There were 15 (71.4%) Stage 1a, 4 (19.1%) Stage 1b, and 2 (9.5%) Stage 3 patients. Total excision of the lesion was achieved in 19 patients (90.5%). We operated on only one patient for a second time, because of a residual lesion, and we resected the lesion totally. Only two patients developed necrosis of the scalp (button hole). Both scalp necroses were on the frontal area. Other patients all had good cosmetic results. Surgical resection of cirsoid aneurysms seems to be the most effective treatment with good results. There may be a tendency for the occurrence of necrosis on the frontal area. Staging of the scalp aneurysms has no effect on surgical outcome.