Multidisciplinary Approach in the Management of Head and Neck Vascular Malformations

Abstract

Purpose: Arteriovenous malformations (AVM) of the head and neck are rare anomalies, but often present with significant haemorrhage or cosmetic defects. The purpose of this study is to determine the effectiveness of embolization of each type of vascular malformation. Methods: A retrospective review was performed between January 2009 to June 2015 on 36 patients who were diagnosed vascular malformations in the head and neck regions and were referred to our department for transarterial or percutaneous embolization before the surgical approach. Results: All 26 AVM were embolized with a transarterial approach: 18 with Onyx, 8 with a combination of PVA and coils. All patients with an AVM had a single endovascular approach. All 10 venous-lymphatic malformations were treated with a percutaneous sclerotherapy with ethanol injection. Complete healing was obtained in 30 patients (83%). In 6 (17%) there was a recurrence with necessity of a retreatment, 4 at 6 months, 2 at 12 months. Conclusion: Transarterial embolization and percutaneous scleroterapy is a safe treatment for artero-venous malformations before the surgical treatment. A multidisciplinary approach is fundamental to reduce the bleeding risks, the time of the surgical intervention and favouring a lesser demolitive approach particularly in large vascular malformations. Surgical complications occurred in 6 patients (17%); all of them developed infections of the surgical wounds; 3 of these developed necrosis of the skin flap used for the reconstruction with subsequent dehiscence. No other complications including sepsis, hemorrhages, cranial nerve palsies or neuropathies occurred.