Intraoperative Ultrasound-Guided Resection for Extracranial Arteriovenous Malformations of the Head and Neck

Abstract

Objectives: Arteriovenous malformations (AVM) are a highly aggressive and difficult to manage disease. Treatments such as proximal ligation, partial embolization, and incomplete surgical removal often lead to a relapse that is worse than the “virgin” condition. Thus, when surgery is chosen with curative purposes, a radical resection must be obtained. Color Doppler can offer a way to more reliably plan resection margins and, if needed, extend the excision of the AVM to obtain radicality. Methods: Nine patients with S1–S3 facial AVMs underwent radical surgical resection with the aid of Color Doppler Ultrasound (CDUS). CDUS was used to define the margins of the exeresis, to check for residual disease and, in case, to extend the resection. Primary closure or local flaps were used to reconstruct the defect. Results: Histology showed AVM-free margins in the 5 patients where CDUS showed no signs of residual disease. In 4 cases, the resection was secondarily widened according to the US findings. Here, the histology showed remnants of the nidus in the part close to the original resection and no disease elsewhere in the remainder of the specimen. At a 24–62 months follow-up, no patient showed signs of relapse. Conclusion: The use of CDUS seems to guarantee a higher degree of cure rate for “healable” AVMs that are managed by means of surgery. Since its introduction in our clinical practice, we routinely use this method in the management of AVMs that are amenable to radical removal.