1
|
Wang Q, Wu YX, Zhang MX, Song DQ, Su BL, Li SM, Shan WY, Liu ZJ, Luo CF, Yu LJ. Efficacy of Bleomycin-Lauromacrogol Foam in Pediatric Macrocystic Lymphatic Malformations With and Without Intracapsular Hemorrhage. J Pediatr Surg 2024; 59:1128-1134. [PMID: 38368195 DOI: 10.1016/j.jpedsurg.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/14/2024] [Accepted: 01/26/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Sclerotherapy is purportedly less effective in patients with hemorrhagic than with non-hemorrhagic lymphatic malformations (LMs). We aimed to compare the efficacy of bleomycin-lauromacrogol foam (BLF) sclerotherapy in the treatment of macrocystic LMs with and without intralesional hemorrhage. METHODS Fifty-five children with macrocystic LMs admitted to the Pediatric Surgery Department were retrospectively included. The patients were allocated into a hemorrhage group (23 cases) or a non-hemorrhage group (32 cases) based on the occurrence of an intracapsular hemorrhage. The diagnosis was confirmed by physical examination, color ultrasound, magnetic resonance imaging, and puncture findings. BLF was injected into the capsule after draining the cystic fluid under color ultrasound guidance. Patients whose lesions were unchanged or showed minor change after 1 month were treated again using the same method. Changes in lesion size and the number of treatments were recorded. Effectiveness was classified as excellent (volume reduction ≥90%), good (50%≤volume reduction<90%), or poor (volume reduction <50%). RESULTS In the hemorrhage group, 17, 6, and 0 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 100%. In the non-hemorrhage group, 23, 7, and 2 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 93.8%. There was no significant difference in efficacy rate between groups (P = 0.767). CONCLUSIONS BLF is an effective and safe treatment for macrocystic LMs with bleeding. The results were similar in patients with and without bleeding. LEVEL OF EVIDENCE Treatment, Level III.
Collapse
Affiliation(s)
- Qian Wang
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Yi-Xin Wu
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Mei-Xian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Dai-Qiang Song
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Bao-Li Su
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Sheng-Miao Li
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Wang-Yong Shan
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Zheng-Ji Liu
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Chun-Fen Luo
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, 317000, Zhejiang, China.
| | - Lin-Jun Yu
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, 317000, Zhejiang, China.
| |
Collapse
|
2
|
Altuwaijri TA. Soft tissue sarcoma mimicking an arteriovenous malformation - A case report and review of literature. Int J Surg Case Rep 2024; 119:109727. [PMID: 38696930 PMCID: PMC11070229 DOI: 10.1016/j.ijscr.2024.109727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Arteriovenous malformation (AVM) is a rare condition affecting less than 5/10,000 people, with high misdiagnosis due to its heterogeneity, inconsistent nomenclature, and diverse diagnostic criteria. Understanding its prevalence in this age group is crucial for effective treatment. Here we present a case report of a patient with AVM. IRB approval and patient consent were obtained. This study was done based on SCARE criteria. CASE PRESENTATION A 53-year-old female patient was diagnosed with a right hip vascular mass suggestive of AVM. The patient reported painless swelling on the right hip for five years, initially increasing in size but significantly increasing in the last six months. The patient had no history of trauma, neurological or pelvic symptoms, or constitutional symptoms. An examination of the lower limbs revealed a firm, non-tender mass measuring approximately 15 × 15 cm. A thigh MRI revealed a sizable, well-rounded, lobulated soft tissue mass with a stromal structure and pronounced vascularity, indicative of a soft tissue tumor. CLINICAL DISCUSSION AVMs misdiagnosis is a significant issue, with 40 % of soft tissue sarcomas still misdiagnosed delaying care and leading to unnecessary measures. A 2015 study found 42.5 % of AMV patients were misdiagnosed, and 71 % were misdiagnosed as hemangiomas. Management involves multidisciplinary approaches, including radiology, sclerotherapy, surgical resection, and chemo/radiotherapy. Sirolimus may improve AVM prognosis. CONCLUSION Misdiagnosis of AVMs is a significant issue, with 40 % of soft tissue sarcomas still misdiagnosed. Management involves multidisciplinary approaches, including interventional radiology, sclerotherapy, surgical resection, and chemo/radiotherapy.
Collapse
Affiliation(s)
- Talal A Altuwaijri
- Department of Surgery, College of Medicine, King Saud University, Saudi Arabia.
| |
Collapse
|
3
|
Chen W, Xu H, Zhang L, Xu R, Li X, Sun G. Imaging manifestations of head and neck lymphatic malformations: A single-center experience of 170 surgical cases. Head Neck 2024; 46:1475-1485. [PMID: 38337167 DOI: 10.1002/hed.27678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To discuss the imaging manifestations and the utility of preoperative ultrasonography (US), contrast-enhanced computed tomography (CE-CT) and contrast enhanced magnetic resonance imaging (CE-MRI) in diagnosing the pediatric head and neck lymphatic malformations (HNLMs). METHODS We performed a retrospective review of 170 children who were referred to our hospital in the past 9 years for the treatment of HNLMs. RESULTS The diagnostic rates of US, CE-CT and CE-MRI were 93.0% (146/157), 94.7% (143/151) and 100% (45/45), respectively. As in multilocular cases, intracystic septa detection rate was 91.5% (130/142), 50.4% (68/135) and 88.1% (37/42), and which had a statistical difference (χ2 = 25.8131, p < 0.05). US showed capsule contents anechoic in 51.0% (80/157) cases, hypoechoic or mixed echoic in 49.0% (77/157) cases, and flocculent or dotted echo floating in 36.9% (58/157) cases. CT showed low density of the capsule contents without enhancement in 69.5% (105/151) cases and mixed density with enhancement in 30.4% (46/151) cases. Liquid-liquid levers were seen in 8.6% (13/151) cases. MRI showed T1WI high signal and T2WI low signal of the capsule contents without enhancement in 28.9% (13/45) cases and mixed density in 71.1% (32/45) cases. Liquid-liquid levers were seen in 46.7% (21/45) cases. There were statistically significant differences between pure HNLMs and intracystic hemorrhage in capsule content (echo, density, signal), enhancement, and liquid-liquid lever (all p < 0.05). Among US, CE-CT and CE-MRI, intracystic hemorrhage diagnostic accuracy had a statistical difference (χ2 = 25.4152, p < 0.05). CONCLUSIONS For clinical diagnosis and evaluation of HNLMs, we suggest that US combined with CE-CT for acute cases, and for stable cases, US combined with CE-MRI.
Collapse
Affiliation(s)
- Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lina Zhang
- Department of Medical Statistics, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Xu
- Department of Radiology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guangbin Sun
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
4
|
Gatts J, Chandra SR, Ricci K. Medical Management and Therapeutic Updates on Vascular Anomalies of the Head and Neck: Part 2. Oral Maxillofac Surg Clin North Am 2024; 36:115-123. [PMID: 37981343 DOI: 10.1016/j.coms.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Discovery of inherited and somatic genetic mutations, along with advancements in clinical and scientific research, has improved understanding of vascular anomalies and changed the treatment paradigm. With aim of minimizing need for invasive procedures and improving disease outcomes, molecularly targeted medications and anti-angiogenesis agents have become important as both adjuncts to surgery, and increasingly, as the primary treatment of vascular anomalies. This article highlights the commonly used and emerging therapeutic medications for non-malignant vascular tumors and vascular malformations in addition to medical management of associated hematologic abnormalities.
Collapse
Affiliation(s)
- Jorie Gatts
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Srinivasa R Chandra
- Department of Oral and Maxillofacial Surgery, Oregon Health and Sciences University, Portland, OR, USA.
| | - Kiersten Ricci
- Hemangioma and Vascular Malformation Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH 45229, USA
| |
Collapse
|
5
|
Shi X, Liu Y, Li D, Tursun M, Azmoun S, Liu S. The Stability of Physician-Compounded Foam is Influenced by the Angle of Connector. Ann Vasc Surg 2024; 99:217-222. [PMID: 37852364 DOI: 10.1016/j.avsg.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Foam sclerotherapy is an effective treatment for varicose veins and venous malformations, with its efficacy influenced by foam stability. The methods for preparing physician-compounded foam (PCF) are the double syringe system (DSS) and Tessari method. Few studies have been performed to compare the PCF stability produced by the 2 methods and their mechanisms. We aim to compare the stability of PCF produced by 2 two methods in the same connector and explore the reasons for the difference. METHODS Foam was generated by the 2 methods under different circumstances. In the Tessari method, 2 syringes were connected at right angles (90°) by a 3-way tap. In the DSS method, 2 syringes were connected by the same 3-way tap in a straight line (180°). The stability and uniformity of foam produced by the 2 methods were compared using foam half-time and optical microscopy, respectively. Assuming that the difference in foam stability between the 2 methods was related to the angles of a connector, we compared the foam stability when 2 syringes were connected with a plastic connector bent to different angles. RESULTS The DSS method could produce more uniform foam with longer foam half-time than the Tessari method, which was related to the angle of the connector. CONCLUSIONS The stability of PCF is influenced by the angle of the connector.
Collapse
Affiliation(s)
- Xuanxuan Shi
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yiran Liu
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Dongjian Li
- Department of Plastic and Burn Surgery, Qilu Hostiptal of Shandong University, Jinan, Shandong, China
| | - Medina Tursun
- Department of Plastic and Burn Surgery, Qilu Hostiptal of Shandong University, Jinan, Shandong, China
| | - Sajjad Azmoun
- Department of Plastic and Burn Surgery, Qilu Hostiptal of Shandong University, Jinan, Shandong, China
| | - Shaohua Liu
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| |
Collapse
|
6
|
Cavazos R, Patil MS, Gowda SH, Iacobas I, Rosenberg T, Fernandes CJ, Pammi M. Sirolimus for vascular anomalies in the first year of life: a systematic review. J Perinatol 2024:10.1038/s41372-024-01868-9. [PMID: 38245657 DOI: 10.1038/s41372-024-01868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/06/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
Evidence on effectiveness and safety of sirolimus in congenital vascular anomalies in infancy is lacking. We aim to systematically review the efficacy and safety of sirolimus in treating congenital VA in infancy. We searched for and included all studies evaluating sirolimus for VA in the first year of life. The primary outcome was effectiveness. The secondary outcome was safety. We included 84 case series and reports (172 participants). Sirolimus decreased the size of the VA in >50% of participants, most of whom had minor transient side effects, and 27% had no adverse effects at all. When categorized by age (<1 month, 1-5 months and 6-12 months), the effectiveness was similar in all age groups. Available evidence suggests that sirolimus is effective and well tolerated. The effectiveness of sirolimus should be evaluated in a well-designed randomized controlled or observational studies.
Collapse
Affiliation(s)
- Rebeca Cavazos
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA.
| | - Monika S Patil
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Sharada H Gowda
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Ionela Iacobas
- Department of Hematology Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Tara Rosenberg
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Caraciolo J Fernandes
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Mohan Pammi
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
7
|
Chen W, Xu H, Lina Z, Xu M, Li X, Sun G. The value of MRI in the diagnosis of pediatric head and neck lymphatic malformations: A study of 46 surgical cases. Eur J Radiol 2024; 170:111260. [PMID: 38086161 DOI: 10.1016/j.ejrad.2023.111260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/24/2023] [Accepted: 12/09/2023] [Indexed: 01/16/2024]
Abstract
Objective To discuss the value of MRI in diagnosing and evaluating the pediatric head and neck lymphatic malformations (HNLMs). Methods We performed a retrospective review of 46 children who were referred to our hospital in the last decade for the treatment of HNLMs. Results About 34 cases confirmed with intralesional hemorrhage while the capsule contents were dark red or light bloody liquid. The remaining 12 pure HNLMs were filled with yellow clear or watery liquid. The multilocular HNLMs accounted for 95.7 % (44/46). The accuracy of contrast enhanced MRI (CE-MRI) diagnosis of HNLMs was 100 %. On MRI, the HNLMs appeared as irregular shape [95.7 % (44/46)], clear boundary [91.3 % (42/46)], infiltrative growth [91.3 % (42/46)] cystic masses. The cystic wall and septa were hyperintense on T1WI and hypointense on T2WI (100 %), and displayed enhancement. The capsule contents had hypointense on T1WI and hyperintense on T2WI in 18 cases (pure HNLMs,12; intracystic hemorrhage,6), while that of mixed signal in 28 cases (pure HNLMs,0; intracystic hemorrhage,28). Capsule contents were enhanced in 22 cases (pure HNLMs,1; intracystic hemorrhage,21), while the remaining 24 without enhancement (pure HNLMs,11; intracystic hemorrhage,13). Liquid-liquid levers were found in 21 cases (pure HNLMs,0; intracystic hemorrhage,21). There were statistical differences in capsule contents signal, enhancement, and liquid-liquid levels between the two groups (P < 0.05). Conclusions On MRI, HNLMs typically show a thin-walled, well-circumscribed, irregularly shaped, infiltrative, unenhanced, multilocular cystic mass with hypointense on T1WI and hyperintense on T2WI. The capsule wall and septa are hyperintense on T1WI, hypointense on T2WI, and display enhancement. Changes in the signal of capsule contents or appearance of liquid-liquid levels indicate intracystic hemorrhage.
Collapse
Affiliation(s)
- Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China; Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Zhang Lina
- Department of Medical Statistics, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Mengrou Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China.
| | - Guangbin Sun
- Department of Otolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China. sgb223-@hotmail.com
| |
Collapse
|
8
|
Allemang-Trivalle A, Leducq S, Maruani A, Giraudeau B. Designs used in published therapeutic studies of rare superficial vascular anomalies: a systematic literature search. BMC Med Res Methodol 2023; 23:196. [PMID: 37648985 PMCID: PMC10466846 DOI: 10.1186/s12874-023-02017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Rare superficial vascular anomalies represent a wide range of diseases. Their management is difficult given the broad spectrum and the lack of clinical trials assessing treatment efficacy. A randomized clinical trial of vascular anomalies is difficult because of the rarity of the diseases and is enhanced by the population of interest often being children. Therefore, suitable designs are needed. We conducted a methodological systematic literature search to identify designs implemented for investigating the treatment of rare superficial vascular anomalies. METHODS We conducted a literature search on January 25, 2021, of the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov and European Union Clinical Trials Register databases. This systematic methodological literature search was registered at the Prospective Register of Systematic Reviews (PROSPERO: CRD42021232449). Randomized and non-randomized studies were included if they met the following criteria: were prospective studies of rare superficial vascular anomaly therapies, dealt with humans (adults and children) and were published in English from 2000. We excluded case reports/case series reporting fewer than 10 patients, reviews, retrospective studies, animal studies, studies of systemic or common vascular anomalies and non-therapeutic studies. We did not assess risk of bias in the included studies because our review was a methodological one focused on the design used. The review provided a descriptive analysis of relevant features of eligible research studies. RESULTS From 2046 articles identified, we included 97 studies (62 reports and 35 ongoing studies): 25 randomized controlled studies, 7 non-randomized comparative studies, 64 prospective cohorts and 1 case series. Among the 32 comparative studies included, 21 used a parallel-group design. The 11 other studies used different designs such as cross-over, randomized placebo phase, delayed-start, within-person, or challenge-dechallenge-rechallenge or used a historical control group or an observational run-in period. CONCLUSIONS Our systematic literature search highlights the lack of randomized control trials in superficial vascular anomalies due to the rarity of patients and their heterogeneity. New designs are emerging and can overcome the limitations of testing treatments in parallel groups.
Collapse
Affiliation(s)
- Aude Allemang-Trivalle
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France.
- INSERM CIC1415, CHRU de Tours, Tours, France.
| | - Sophie Leducq
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (Maladies Génétiques rares à Expression Cutanée-Tours), CHRU de Tours, Tours, France
| | - Annabel Maruani
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (Maladies Génétiques rares à Expression Cutanée-Tours), CHRU de Tours, Tours, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| |
Collapse
|
9
|
Ye Z, Li C, Liu Y, You M. Intraosseous venous malformation of the zygoma: Case report and pooled analysis. J Craniomaxillofac Surg 2023; 51:490-496. [PMID: 37574385 DOI: 10.1016/j.jcms.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/29/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023] Open
Abstract
The objective of this study is to provide a comprehensive summary of the clinical and radiological features of zygomatic intraosseous venous malformations (IVM), as well as its treatment strategies. The aim is to establish preoperative diagnostic bases that will aid in the identification of zygomatic IVM and facilitate the implementation of effective treatment. Four cases of pathologically diagnosed zygomatic IVM with typical clinical and radiological features were reported. They exhibited comparable clinical and radiological features, and the En bloc excision and reconstruction yielded satisfactory outcome. Pooled data analysis was performed with additional 74 cases collected from 63 previous studies. The results revealed a higher incidence of zygomatic IVMs in middle-aged females, with swelling, pain and ocular dysfunction being the typical clinical manifestations. The characteristic radiological features of these lesions were well-defined, round bony structures with specific internal trabecular patterns. A diagnostic flow-chart assisting the differential diagnosis of IVM was established. En bloc excision was deemed the most advantageous treatment option, as it presented minimal risk of haemorrhaging and no instances of recurrence. The decision to pursue reconstruction was contingent upon the extent of the defect. Alloplastic material has emerged as the most frequently employed reconstruction material in recent reports. The summarized characteristics of zygomatic IVM and the proposed diagnostic and treatment strategies, derived from the pooled analysis of reported cases, may help to improve diagnosis and management in further clinical practice.
Collapse
Affiliation(s)
- Zelin Ye
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Chenyang Li
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - YuanYuan Liu
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Meng You
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
10
|
Arya P, Prickett KK, Raol N, Briones M, Evans S. Sirolimus-induced pulmonary hemorrhage of an infant with massive cervicofacial lymphatic malformation: A case report. Int J Pediatr Otorhinolaryngol 2023; 164:111404. [PMID: 36469963 DOI: 10.1016/j.ijporl.2022.111404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Lymphatic malformations (LMs) are uncommon congenital abnormalities of the lymphatic system. As more than half of these lesions develop in the head and neck, LMs can be life-threatening if associated with airway involvement. LMs necessitate a multidisciplinary treatment approach, frequently including surgery and sclerotherapy. We present a case report of a 32-week pre-term male infant with a massive cervicofacial LM necessitating delivery via ex-utero intrapartum treatment (EXIT). The patient was treated with numerous rounds of sclerotherapy, systemic sirolimus, and surgical debulking, but ultimately died at 4 months of age due to acute pulmonary hemorrhage, which may have been related to sirolimus due to the absence of any other associable organ involvement or derangement. We document the patient's clinical course and treatment regimen, highlighting the myriad modalities employed to treat these challenging lesions, and describe a potentially lethal complication of sirolimus therapy not previously described in the treatment of pediatric LM.
Collapse
Affiliation(s)
- Priya Arya
- Mercer University School of Medicine, 1250 E 66th St, Savannah, GA, 31404, USA
| | - Kara K Prickett
- Children's Healthcare of Atlanta, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA; Emory University School of Medicine, Department of Otolaryngology, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA; Emory University School of Medicine, Department of Otolaryngology, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Michael Briones
- Children's Healthcare of Atlanta, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA; Emory University School of Medicine, Department of Otolaryngology, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Sean Evans
- Children's Healthcare of Atlanta, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA; Emory University School of Medicine, Department of Otolaryngology, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
| |
Collapse
|
11
|
Maruyama F, Masuda T, Nosaka N, Wakabayashi K. Case of laryngeal venous malformations requiring repeated advanced airway management in the perioperative course. Clin Case Rep 2022; 10:e6687. [PMID: 36483877 PMCID: PMC9723375 DOI: 10.1002/ccr3.6687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Laryngeal venous malformations rarely but do cause airway obstruction resulting in life-threatening events. The perioperative airway management for the patients with them has not been well established. We suggest a strategy for laryngeal venous malformations management in the patients who undergo surgery in addition to planning for airway management.
Collapse
Affiliation(s)
- Fumi Maruyama
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Takahiro Masuda
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Nobuyuki Nosaka
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Kenji Wakabayashi
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| |
Collapse
|
12
|
Krt A, Cemazar M, Lovric D, Sersa G, Jamsek C, Groselj A. Combining superselective catheterization and electrochemotherapy: A new technological approach to the treatment of high-flow head and neck vascular malformations. Front Oncol 2022; 12:1025270. [DOI: 10.3389/fonc.2022.1025270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
IntroductionThe study aims to demonstrate a combination of superselective catheterization and electrochemotherapy as a feasible and effective new technological approach in treating high-flow vascular malformations of the head and neck region.Patients and methodsIn the patient with high-flow arteriovenous malformation of the lower lip, superselective catheterization was performed under general anesthesia. The microcatheter was used to administer 750 IU BLM intra-arterially into the feeding vessel. The whole malformation surface was then covered with 15 applications of electric pulses using the plate electrode.ResultsExcellent response, without functional or aesthetic deficits, was obtained in 10 weeks. During this period, debridement and necrectomy were performed regularly on follow-up visits. The pain was managed with oral paracetamol and sodium metamizole.ConclusionCombining electrochemotherapy using bleomycin with superselective catheterization and arteriography is a feasible treatment option for high-flow vascular malformations in the head and neck region and could play a significant role in managing these challenging lesions.
Collapse
|
13
|
Huang B, Zhang P, Zhong YY, Wang K, Chen XM, Yu DJ. Transcriptional data analysis reveals the association between infantile hemangiomas and venous malformations. Front Genet 2022; 13:1045244. [PMID: 36338963 PMCID: PMC9626979 DOI: 10.3389/fgene.2022.1045244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Infantile hemangiomas (IH) and venous malformations (VM) are the most common types of vascular abnormalities that seriously affect the health of children. Although there is evidence that these two diseases share some common genetic changes, the underlying mechanisms need to be further studied. Methods: The microarray datasets of IH (GSE127487) and VM (GSE7190) were downloaded from GEO database. Extensive bioinformatics methods were used to investigate the common differentially expressed genes (DEGs) of IH and VM, and to estimate their Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Trough the constructing of protein-protein interaction (PPI) network, gene models and hub genes were obtained by using Cytoscape and STRING. Finally, we analyzed the co-expression and the TF-mRNA-microRNA regulatory network of hub genes. Results: A total of 144 common DEGs were identified between IH and VM. Functional analysis indicated their important role in cell growth, regulation of vasculature development and regulation of angiogenesis. Five hub genes (CTNNB1, IL6, CD34, IGF2, MAPK11) and two microRNA (has-miR-141-3p, has-miR-150-5p) were significantly differentially expressed between IH and normal control (p < 0.05). Conclusion: In conclusion, our study investigated the common DEGs and molecular mechanism in IH and VM. Identified hub genes and signaling pathways can regulate both diseases simultaneously. This study provides insight into the crosstalk of IH and VM and obtains several biomarkers relevant to the diagnosis and pathophysiology of vascular abnormalities.
Collapse
Affiliation(s)
- Biao Huang
- Department of Plastic and Burn Surgery, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Ping Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Yuan-Yuan Zhong
- Department of Health Management Center, The Second Affiliated Hospital of Soochow University, Soochow, China
| | - Kuan Wang
- Department of Plastic Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xiao-Ming Chen
- Department of Plastic and Burn Surgery, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
- *Correspondence: Dao-Jiang Yu, ; Xiao-Ming Chen,
| | - Dao-Jiang Yu
- Department of Plastic and Burn Surgery, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
- *Correspondence: Dao-Jiang Yu, ; Xiao-Ming Chen,
| |
Collapse
|
14
|
Kao E, Cohan C, Jaramillo E, Jean-Pierre J, Levine A, Aarabi S. Surgical management of bilateral thoracic outlet lymphaticovenous malformations causing recurrent cerebrovascular accidents. J Vasc Surg Cases Innov Tech 2022; 8:429-432. [PMID: 35996729 PMCID: PMC9391521 DOI: 10.1016/j.jvscit.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/19/2022] [Indexed: 11/15/2022] Open
Abstract
Lymphaticovenous malformations (LVMs) are a rare subset of congenital vascular malformations that result from the defective development of the vascular and lymphatic systems during embryogenesis. LVMs can cause pathological mass effects or lead to thrombotic complications. We present a rare case of the surgical management of bilateral LVMs arising at the junction of the brachiocephalic and internal jugular veins in a patient with a patent foramen ovale, identifying the source of previously unexplained paradoxical cerebrovascular accidents.
Collapse
|
15
|
Giese RA, Valero C, Shah JP. Surgical management of vascular tumors and malformations of the head and neck in adults. J Oral Pathol Med 2022; 51:854-859. [PMID: 35467767 DOI: 10.1111/jop.13302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
Vascular tumors and malformations present a diagnostic and therapeutic challenge to many physicians. Because these lesions are rare, few surgeons have enough experience with them other than those practicing in tertiary vascular anomaly treatment centers. Some patients may have been misdiagnosed or mistreated during childhood and present in adult age with either recurrence or with an untreated lesion. Ideally, a multidisciplinary treatment team should be involved to discuss management with the patient including specialists in surgery, interventional radiology, pathology, hematology, genetics, and dermatology. As our understanding of the pathogenesis of these lesions grows, novel therapies are being employed which may decrease the need for surgery. Nevertheless, some lesions need definitive treatment with surgery. Improving understanding of the surgical management of vascular anomalies will improve cosmetic and functional outcomes for patients.
Collapse
Affiliation(s)
- Rachel A Giese
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Cristina Valero
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| |
Collapse
|
16
|
Karmacharya RM, Vaidya S, Bhatt S, Gyawali K, Milan J, Karkee D, Gyawali G, Marasini S. Combined vascular malformation of neck: A case report. Ann Med Surg (Lond) 2022; 76:103531. [PMID: 35495388 PMCID: PMC9052240 DOI: 10.1016/j.amsu.2022.103531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/11/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2022] Open
Abstract
Vascular malformations are developmental anomalies occurring due to defective vasculogenesis. Depending on the number of vessels involved, they are subgrouped into simple or combined types. Combined vascular malformations are a rare clinical entity with two or more vascular malformations (capillary, venous, arteriovenous, lymphatic) present in one lesion. Due to the complexity of these lesions, clinicians should employ an interdisciplinary approach with multi-staged treatment for the proper management. Here, we report a case of a lady with a combined vascular malformation in the right side of the neck who presented to our department with a complaint of progressively increasing swelling for three months. A multidisciplinary team of vascular surgeons, interventional radiologists and physiotherapists were involved in its treatment. Initially, Doppler ultrasonography was performed, which revealed a vascular lesion with arterial and venous components and a flow void region suggestive of lymphatic malformation, further confirmed by magnetic resonance imaging (MRI). A multistage treatment modality was employed where intralesional steroid was initially administered in the lesion area to shrink the vessel's size. Next, venous malformation targeted sclerotherapy was performed preoperatively, followed by intraoperative ligation of the feeding vessel and excision of remaining malformation. Postoperatively the patient had no wound site complication and was discharged on the fourth postoperative day with advice to follow rehabilitative neck exercises. One month follow-up revealed complete resolution of the malformation. Thus, in the case of combined vascular malformation, multistage treatment modalities with a multidisciplinary team should be employed for proper treatment. A rare case of combined arterio-lymphatico-venous malformation on the right side of the neck. Successful multimodal treatment by intralesional steroid injection, ligation of feeding vessel, resection of malformation, and sclerotherapy.
Collapse
Affiliation(s)
- Robin Man Karmacharya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Satish Vaidya
- Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
- Corresponding author.
| | - Kamana Gyawali
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - J.N. Milan
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Diwas Karkee
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Garima Gyawali
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| | - Sujita Marasini
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, 45210, Nepal
| |
Collapse
|
17
|
Gorostidi F, Glasson N, Salati V, Sandu K. Pediatric vascular anomalies with airway compromise. J Oral Pathol Med 2022; 51:888-896. [PMID: 35347777 PMCID: PMC10084185 DOI: 10.1111/jop.13297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/08/2022] [Indexed: 11/27/2022]
Abstract
Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or compromise it. The absolute priority, before etiologic treatment, is the evaluation of the risk for the airway and its management. Prenatal diagnosis of an upper airway obstruction requires a planned delivery in a center having a specialized team experienced in managing a compromised feto-neonatal airway, and who could perform an ex-utero intrapartum treatment to secure the airway. Even after birth, the airway remains central in the patient's overall management. Signs and symptoms of airway compromise must be evaluated keeping in mind the specific requirements of infants and small children and being aware that rapid worsening may occur. The treatment is then tailored to the patient and his lesion with the goal of improving symptoms while avoiding treatment-related complications. Maintaining reasonable expectations by the patient and families are part of a successful management. Cure is achievable for small and localized lesions, but symptom relief and mitigation of functional, esthetic and psychological impairments is the goal for large and complex lesions. If a tracheotomy was required, decannulation is one of the primary management goals.
Collapse
Affiliation(s)
- François Gorostidi
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nicolas Glasson
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Victoria Salati
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kishore Sandu
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
18
|
Liu R, Chen J, Jia L, Pan B, Jiang H. Surgical management of auricular arteriovenous malformations: A literature review. Laryngoscope Investig Otolaryngol 2022; 7:604-613. [PMID: 35434337 PMCID: PMC9008162 DOI: 10.1002/lio2.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/01/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022] Open
Abstract
Auricular arteriovenous malformations (AVMs) can cause a variety of symptoms that seriously impact the patient's appearance, life, and mental well‐being. Surgery is the primary management method for auricular AVMs, but there is no consensus on how to surgically manage auricular AVMs. In this article, we document a comprehensive review of the characteristics, classification, and surgical interventions to treat auricular AVMs.
Collapse
Affiliation(s)
- Ruiquan Liu
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Jianguo Chen
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Litao Jia
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Bo Pan
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Haiyue Jiang
- Department of Auricular Reconstruction Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| |
Collapse
|
19
|
Lymphatic Anomalies in Children: Update on Imaging Diagnosis, Genetics and Treatment. AJR Am J Roentgenol 2022; 218:1089-1101. [PMID: 35043669 DOI: 10.2214/ajr.21.27200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lymphatic anomalies comprise a spectrum of disorders ranging from common localized microcystic and macrocystic lymphatic malformations (LMs) to rare complex lymphatic anomalies, including generalized lymphatic anomaly, Kaposiform lymphangiomatosis, central conducting lymphatic anomaly, and Gorham-Stout disease. Imaging diagnosis of cystic LMs is generally straightforward, but complex lymphatic anomalies, particularly those with multi-organ involvement or diffuse disease, may be more challenging to diagnose. Complex lymphatic anomalies are rare but associated with high morbidity. Imaging plays an important role in their diagnosis, and radiologists may be the first clinicians to suggest the diagnosis. Furthermore, radiologists are regularly involved in management given the frequent need for image-guided interventions. For these reasons, it is crucial for radiologists to be familiar with the spectrum of entities comprising complex lymphatic anomalies and their typical imaging findings. In this article, we review the imaging findings of lymphatic anomalies, including LMs and complex lymphatic anomalies. We discuss characteristic imaging findings, multimodality imaging techniques used for evaluation, pearls and pitfalls in diagnosis, and potential complications. We also review recently discovered genetic changes underlying lymphatic anomaly development and the advent of new molecularly targeted therapies.
Collapse
|
20
|
Guedes HJ, Kuramoto DAB, Correia RM, Santos BC, Borges ADC, Pereda MR, Aidar ALES, Pereira FA, Amaral FCDF, de Vasconcelos VT, Lustre WG, de Amorim JE, Flumignan RLG, Nakano LCU, Baptista-Silva JCC. What do Cochrane systematic reviews say about congenital vascular anomalies and hemangiomas? A narrative review. SAO PAULO MED J 2022; 140:320-327. [PMID: 35293939 PMCID: PMC9610242 DOI: 10.1590/1516-3180.2021.0374.r2.15092021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Congenital vascular anomalies and hemangiomas (CVAH) such as infantile hemangiomas, port-wine stains and brain arteriovenous malformations (AVMs) impair patients' lives and may require treatment if complications occur. However, a great variety of treatments for those conditions exist and the best interventions remain under discussion. OBJECTIVE To summarize Cochrane systematic review (SR) evidence on treatments for CVAH. DESIGN AND SETTING Review of SRs conducted in the Division of Vascular and Endovascular Surgery of Universidade Federal de São Paulo, Brazil. METHODS A broad search was conducted on March 9, 2021, in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed treatments for CVAH. The key characteristics and results of all SRs included were summarized and discussed. RESULTS A total of three SRs fulfilled the inclusion criteria and were presented as a qualitative synthesis. One SR reported a significant clinical reduction of skin redness by at least 20%, with more pain, among 103 participants with port-wine stains. One SR reported that propranolol improved the likelihood of clearance 13 to 16-fold among 312 children with hemangiomas. One SR reported that the relative risk of death or dependence was 2.53 times greater in the intervention arm than with conservative management, among 218 participants with brain AVMs. CONCLUSION Cochrane reviews suggest that treatment of port-wine stains with pulsed-dye laser improves redness; propranolol remains the best option for infantile hemangiomas; and conservative management seems to be superior to surgical intervention for treating brain AVMs.
Collapse
Affiliation(s)
- Henrique Jorge Guedes
- MD, PhD. Adjunct Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Danielle Akemi Bergara Kuramoto
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Rebeca Mangabeira Correia
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Brena Costa Santos
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Amanda da Cunha Borges
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Mariana Raffo Pereda
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Ana Laura e Silva Aidar
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Francisco Amadeu Pereira
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Fabio Cabral de Freitas Amaral
- MD. Postgraduate Student, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Vladimir Tonello de Vasconcelos
- MD, PhD. Adjunct Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Wellington Gianoti Lustre
- MD, MSc. Assistant Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Jorge Eduardo de Amorim
- MD, PhD. Adjunct Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Ronald Luiz Gomes Flumignan
- MD, PhD. Full Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Luis Carlos Uta Nakano
- MD, PhD. Full Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - José Carlos Costa Baptista-Silva
- MD, PhD. Full Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| |
Collapse
|
21
|
Naidu V, Quddus A, Khurram R, Karia P, Brookes J. Giant parapharyngeal high-flow arteriovenous malformation causing airway compromise: emergency embolo-sclerotherapy via an endovascular-only approach. Radiol Case Rep 2021; 16:2202-2206. [PMID: 34178192 PMCID: PMC8213983 DOI: 10.1016/j.radcr.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022] Open
Abstract
Head and neck arteriovenous malformations are the commonest extracranial vascular malformations but demonstrate a unique challenge in the limited available surgical options secondary to their intimate association to vital structures. We present a case of middle-aged female patient who presented with threatened upper-airway obstruction and bleeding secondary to a slowly enlarging parapharyngeal arteriovenous malformations. She was treated with an endovascular-only approach with the proximal arteriole branches selectively undergoing embolo-sclerotherapy with an optimal radiological and clinical outcome. We also demonstrate the utility of elective tracheostomy prior to intervention.
Collapse
|
22
|
Mahajan A, Vijan A, Karbhari A. Grapevines in the neck. CANCER RESEARCH, STATISTICS, AND TREATMENT 2021. [DOI: 10.4103/crst.crst_223_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|