Abstract
Aim Image-guided sclerotherapy is becoming the preferred treatment for low-flow vascular
malformations in head and neck region. The authors review the management protocol
for this condition and evaluate its clinical outcomes.
Methods Children with low-flow vascular malformations in head and neck region undergoing
sclerotherapy from 2010 to 2013 were reviewed. All patients were assessed by pediatric
surgeons and interventional radiologists in the multidisciplinary vascular anomalies
clinic. Ultrasonography and intravenous contrast enhanced magnetic resonance imaging
were performed preoperatively. Under general anesthesia with endotracheal intubation,
sclerotherapy were performed with ultrasonographic and fluoroscopic guidance. Sodium
tetradecryl sulfate (STS) foam or ethanolamine was used for venous malformation and
doxycycline for lymphatic malformations as primary sclerosants, whereas 98% ethanol
was reserved as an adjuvant sclerosant in selected cases of repeated procedures. Perioperative
dexamethasone 0.2 mg/kg thrice daily was administered to decrease postsclerotherapy
swelling and single dose intravenous mannitol 0.5 g/kg was given to minimize thromboembolic
complications. Postoperatively, patients were admitted to intensive care unit for
mechanical ventilation under deep sedation for airway protection.
Results Overall 13 children (8 male and 5 female) with a mean age of 25 months (range, 2
mo–11 y) underwent a total of 25 sessions of image-guided staged sclerotherapy. There
were five venous and eight lymphatic malformations. Location wise there were eight
cervical, one lingual, one parotid, one lip, one facial, and one palatal lesions.
Six patients had obstructive airway symptoms. Five patients required staged sclerotherapies
from two to six sessions. There were no airway and thromboembolic complications. One
patient had bleeding while another had recurrent swelling following sclerotherapy
for lymphatic malformations and they were treated by aspiration. Significant size
reductions of more than 50% volume were achieved in all patients. All patients with
obstructive symptoms showed improvement.
Conclusion Sclerotherapy is a safe and effective treatment for head and neck vascular malformations
in children. Routine perioperative protocol is essential to reduce airway and thromboembolic
complications. Size reduction and functional improvement occurred in all patients
undergoing sclerotherapy.
Keywords
vascular malformations - head and neck - sclerotherapy
