Abstract
ObjectiveTo report the clinical and MRI-based volumetric mid-term outcome after image guided percutaneous sclerotherapy (PS) of venous malformations (VM) of the head and neck.MethodsA retrospective analysis of a prospectively maintained database was performed, including patients with VM of the head and neck who were treated with PS. Only patients with available pre- and post-interventional MRI were included into this study. Clinical outcome, which was subjectively assessed by the patients, their parents (for paediatric patients) and/or the physicians, was categorized as worse, unchanged, minor or major improvement. Radiological outcome, determined by MRI-based volumetric measurements, was categorized as worse (>10% increase), unchanged (≤10% increase to <10% decrease), minor (≥10% to <25% decrease), intermediate (≥25% to <50% decrease) or major improvement (≥50% decrease).ResultsTwenty-seven patients were treated in 51 treatment sessions. After a mean follow-up of 31 months, clinical outcome was worse for 7.4%, unchanged for 3.7% of the patients, while there was minor and major improvement for 7.4% and 81.5%, respectively. In the volumetric imaging analysis 7.4% of the VMs were worse and 14.8% were unchanged. Minor improvement was observed in 22.2%, intermediate improvement in 44.4% and major improvement in 11.1%. The rate of permanent complications was 3.7%.ConclusionPS can be an effective therapy to treat the symptoms of patients with VMs of the head and neck and to downsize the VMs. MRI-based volumetry can be used to objectively follow the change in size of the VMs after PS. Relief of symptoms frequently does not require substantial volume reduction.
Highlights
Venous malformations (VMs) are congenital slow-flow vascular malformations with a wide range in size and appearance [1, 2]
After a mean follow-up of 31 months, clinical outcome was worse for 7.4%, unchanged for 3.7% of the patients, while there was minor and major improvement for 7.4% and 81.5%, respectively
Cornerstones of this categorization are the differentiation between vascular tumours and vascular malformations and the subdivision of vascular malformations into simple malformations and combined malformations
Summary
Venous malformations (VMs) are congenital slow-flow vascular malformations with a wide range in size and appearance [1, 2]. The International Society for the Study of Vascular Anomalies (ISSVA) developed a categorization schema based on the inventiveness of Mulliken and Glowacki [1, 6] Cornerstones of this categorization are the differentiation between vascular tumours and vascular malformations and the subdivision of vascular malformations into simple malformations (e.g. venous malformations, lymphatic malformations and high-flow lesions, such as arteriovenous malformations and fistulas) and combined malformations (e.g. venolymphatic malformations). Percutaneous sclerotherapy (PS) is one of the most established treatment methods in combating those symptoms [7, 8] The aim of this therapy is to induce sterile inflammatory reactions, involving the endothelium, which leads to occlusion of the affected vessels and involution of the vascular malformation [9, 10]. The aim of this study was to report the clinical and MRI-based volumetric mid-term outcome in patients with venous malformations of the head and neck who were treated with percutaneous sclerotherapy in our tertiary care centre and to investigate the differences and correlation between clinical and radiological outcomes
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