Interdisciplinary management of craniofacial vascular malformations

Abstract

Beside their sometimes unsightly appearance, vascular malformations of the head and neck area can lead to very severe functional problems. Reduced field of vision and impairments in breathing and swallowing can occur and are serious problems to deal with. During the last 4 years, 17 patients with vascular malformations of the head and neck region were treated in our department. Initially, the patients were evaluated by an interdisciplinary team consisting of specialists in pediatrics, radiology, dermatology, and plastic surgery. A diagnostic algorithm of radiological investigation is established; this consists of gadolinium-enhanced magnetic resonance imaging, magnetic resonance angiography, and multi-slice computer tomography to provide as a basis for individual treatment. In four patients with well identifiable feeding vessels, a two-stage concept consisting of embolization and immediate resection was performed. A detailed explanation of the diagnostic and therapeutic steps with regard to the specific imaging necessities and treatment modalities is outlined. The aim is to emphasize the necessity for a multidisciplinary approach in dealing with large craniofacial vascular malformations. Minimal blood loss, moderate operating time, and overall satisfactory postoperative results, both functional and cosmetic, are the aims of this interdisciplinary management.