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Alghamdi AM, Alboqami RA, Ateeq OH, Aljohani S, Ahmed ME, Samkari A, Kutub H. Combined Preoperative Endovascular Embolization and Surgical Excision for Scalp Arteriovenous Malformations: A Systematic Review and Case Illustration. World Neurosurg 2024; 185:234-244. [PMID: 38428811 DOI: 10.1016/j.wneu.2024.02.121] [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: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report. METHODS A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study. RESULTS A total of 49 articles (91 patients) were included. The patients' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months. CONCLUSIONS The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.
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Affiliation(s)
- Abdulaziz M Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Razan Ayed Alboqami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Orjwan Hashem Ateeq
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Sara Aljohani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Muhammad Ejaz Ahmed
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Medical Imaging, King Abdullah Medical City, Jeddah, Saudi Arabia
| | - Alaa Samkari
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hussam Kutub
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
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Mataro I, Di Franco L, Cavaliere A, Razzano S, Schonauer F, D'Andrea F, d'Alessio R. Extensive severe intraorbital arteriovenous malformations: report of a rare laser complication and successful management. J Wound Care 2023; 32:S4-S8. [PMID: 36630192 DOI: 10.12968/jowc.2023.32.sup1.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Arteriovenous malformations (AVMs) are rare congenital errors of vascular morphogenesis, characterised by abnormal direct communications between arteries and veins, bypassing the normal capillary bed. Apart from the central nervous system, typical locations include the head and neck, and less frequently limbs, trunk or internal organs. AVMs of the head and neck often become clinically evident and symptomatic only in later childhood and are characterised by a history of variable growth, sometimes leading to large, deforming, pulsating masses with a propensity to massive haemorrhage. Therapeutic strategy is based on selective embolisation, surgical excision, or a combination of both. Radical surgical excision of local AVMs is the only effective treatment but it may be mutilating, especially for AVMs of the head and neck. Laser therapy represents a good option to treat the cutaneous aspects of AVMs nevertheless, its efficacy is limited. To the date, pharmacological therapy for AVMs is still on debate due to its controversial outcomes as it seems not as effective as other treatments and usually requires a longer course of application. However, pharmacological therapy could be useful in selected patients and for AVMs nonresponsive to traditional treatment, allowing them to obtain acceptable results without serious complications. This paper reports the case of a serious laser complication of extensive intraorbital AVM successfully treated by local reconstruction and topical pharmacological treatment.
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Affiliation(s)
- Ilaria Mataro
- Plastic and Reconstructive Surgery and Burn Unit, Hospital 'A. Cardarelli', Naples, Italy
| | - Livia Di Franco
- Resident Doctor in General Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Annachiara Cavaliere
- Department of Plastic and Reconstructive Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Sergio Razzano
- Plastic and Reconstructive Surgery and Burn Unit, Hospital 'A. Cardarelli', Naples, Italy
| | - Fabrizio Schonauer
- Department of Plastic and Reconstructive Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Francesco D'Andrea
- Department of Plastic and Reconstructive Surgery, Federico II University Hospital, Via Pansini 5, Naples, Italy
| | - Roberto d'Alessio
- Plastic and Reconstructive Surgery and Burn Unit, Hospital 'A. Cardarelli', Naples, Italy
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Goldenberg DC, Zatz RF. Surgical Treatment of Vascular Anomalies. Dermatol Clin 2022; 40:473-480. [DOI: 10.1016/j.det.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Azis KA, Koh KL, Wan Sulaiman WA, Al-Chalabi MMM. Extracranial Arteriovenous Malformations Rupture in Pregnancy. Cureus 2022; 14:e22798. [PMID: 35399437 PMCID: PMC8980199 DOI: 10.7759/cureus.22798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/05/2022] Open
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Abi Zeid Daou C, Korban ZR. A Venous Malformation of the Inferior Turbinate: A Case Report with Review of the Literature. Indian J Otolaryngol Head Neck Surg 2019; 71:2143-2147. [PMID: 31763311 PMCID: PMC6848671 DOI: 10.1007/s12070-019-01635-9] [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: 02/18/2019] [Accepted: 03/16/2019] [Indexed: 11/26/2022] Open
Abstract
Arteriovenous Malformations of the head and neck are rare vascular anomalies that can be aggressive and lethal. It is crucial to have a high clinical suspicion to avoid the consequent mortality and morbidity that may result from bleeding. We present the case of a rare inferior turbinate venous malformation in a 17 year old female that presented with epistaxis and was treated with surgery. Treatment varies and depends on the stage; however complete resection should be the goal to prevent recurrence. The endoscopic endonasal approach is minimally invasive, safe and effective in selected patients.
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Affiliation(s)
- Christophe Abi Zeid Daou
- American University of Beirut Medical Center, American University of Beirut, PO Box: 11-0236, Riad El Solh, 1107 2020 Beirut, Lebanon
| | - Zeina R. Korban
- American University of Beirut Medical Center, American University of Beirut, PO Box: 11-0236, Riad El Solh, 1107 2020 Beirut, Lebanon
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The Superficial Temporal Artery Island Flap: An Option for Moustache Reconstruction. J Craniofac Surg 2019; 30:e404-e406. [PMID: 31299793 DOI: 10.1097/scs.0000000000005344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Vascular anomalies are a group of lesions originating from blood vessels and lymphatics with varying histology and clinical behavior. They form the most common congenital anomalies in infants and children. The reconstructive method for the facial region defects varies depending on the size and position of the defect, as well as the patient's age, health status and aesthetic concerns. In this case, the authors present a male patient who underwent a wide resection of his mustache area because of vascular malformation and reconstructed with hair-bearing temporal artery island flap.A 42-year-old male patient presented with swelling and ongoing color change in the cheek and lip area on the left side of the face. His examination revealed a vascular malformation extending from the preauricular region to the left side of the nose, to the upper lip and to the medial canthal region. Superficial temporal artery island flap was designed to reconstruct the upper lip area while full thickness skin graft planned for the defect on nose and cheek.STA island flap has been applied in many areas such as forehead, eyebrow, eyelid, cheek, and nose reconstruction due to its advantages such as providing good color and texture harmony, reliable and constant pedicle, simple and fast dissection, wide rotation arc and low donor area morbidity. Superficial temporal artery island flap should be considered as a favorable reconstruction option in upper and middle face region for moderate and small sized defects.
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Surgical management of a nasal AVM in a pediatric patient: A case report. JPRAS Open 2018; 16:93-97. [PMID: 32158817 PMCID: PMC7061621 DOI: 10.1016/j.jpra.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
Arteriovenous malformations (AVMs) are a type of high-flow vascular malformation that are characterized by abnormal capillary communications between the arterial and venous systems. While they are most commonly located in the head and neck region, their appearance in the nose is considerably rare, resulting in a paucity of literature regarding the surgical management of these lesions. We present the case of a 13-year-old male with a 6.5 × 6 cm AVM of the nose with a history of frequent nosebleeds since early childhood, often requiring aggressive measures, such as silver nitrate cauterization for control. Use of nasal decongestants and aminocaproic acid provided only transient improvement. After determination of arterial supply, AVM was approached with a combination of preoperative selective embolization and surgical excision with subsequent forehead flap defect coverage. Due to the size and complexity of this AVM, extra precautions were taken to avoid severe intraoperative bleeding, and femoral sheaths were placed prior to excision. The patient tolerated the procedure well, and with subsequent debulking surgery and Laser Hair Removal achieved an acceptable cosmetic outcome.
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Arterio-Venous Malformations of the Nose: Combined Approach for a Successful Strategy. J Craniofac Surg 2018; 27:1524-6. [PMID: 27607121 DOI: 10.1097/scs.0000000000002777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of the present study is to evaluate the vascular malformations of the head and neck. They are uncommon lesions, but some areas have a significant potential for fatality, due to their massive bleeding. The vascular anatomy of the nose carries a high recurrence rate, due to the unique characteristic of the nose, especially if deep vascular connection is present. METHODS The present article describes 2 patients of nasal dorsum arteriovenous malformations, both using a combined procedure: preoperative selective embolization, en-bloc tumor resection, and reconstruction with a forehead flap. Two female patients with arterio-venous malformations of the nose were examined, subjected to excision procedure and forehead flap reconstruction. Current treatment requires surgical resection of the nose and in conjunction with adjunctive endovascular embolization; it reduces arterio-venous malformations recurrence. RESULTS The authors report an endovascular and surgical technique to treat nasal arterio-venous malformations, which permits a complete resection and a reconstruction with a forehead flap. There were no major complications such as recurrent ulceration, infection, postoperative bleeding, or flap failure. All the patients responded positively and satisfactory results were achieved in both female patients. CONCLUSIONS To reduce the recurrence of arterio-venous malformations, the multidisciplinary therapy is mandatory. Recent advances in microsurgery and interventional radiology have greatly improved prognosis for patients with arterio-venous malformations. Therefore, a preoperative selective embolization followed by surgical excision seems to be a good compromise for arterio-venous malformations therapy. The forehead flap, for its characteristics, represents the better choice for nasal reconstruction.
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Lin CS, Lin YS, Lin BS, Lien CF, Liu CF. Radial forearm and forehead flap reconstruction following resection of a nasal arteriovenous malformation: A case report. Oncol Lett 2016; 12:2868-2871. [PMID: 27698872 DOI: 10.3892/ol.2016.5022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/22/2016] [Indexed: 11/05/2022] Open
Abstract
Arteriovenous malformation (AVM) is a structural vascular abnormality in which the arterial vasculature connects with the venous vasculature without capillary connections. AVM confined to the nasal cavity is considerably rare. Blurred vision can be one of the associated symptoms. A combined approach of complete surgical resection with prior superselective embolization is the treatment of choice. Following resection, the reconstruction of facial defects, particularly in the nasal area, is challenging. The present study reports the rare case of a patient with an AVM in the nasal cavity, in which embolization, resection and flap reconstruction were performed. Embolization and complete surgical resection were used to avoid recurrence. Subsequently, a combination of free radial forearm and forehead flaps was used for the reconstruction of the nasal defect, without prosthesis. To the best of our knowledge, this is the first report of AVM confined to the nasal cavity, managed by a combination of free radial forearm and forehead flap reconstruction following complete resection. The cosmetic results of the procedure were acceptable.
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Affiliation(s)
- Chih-Shin Lin
- Department of Otolaryngology, Chi-Mei Medical Center, Tainan 710, Taiwan, R.O.C
| | - Yung-Song Lin
- Department of Otolaryngology, Chi-Mei Medical Center, Tainan 710, Taiwan, R.O.C
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 711, Taiwan, R.O.C
| | - Ching-Feng Lien
- Department of Otolaryngology, E-DA Hospital and I-Shou University, Kaohsiung 84001, Taiwan, R.O.C
| | - Ching-Feng Liu
- Department of Otolaryngology, Chi-Mei Medical Center, Tainan 710, Taiwan, R.O.C.; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan 300, R.O.C
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Su L, Wang D, Han Y, Wang Z, Zheng L, Fan X. Absolute Ethanol Embolization of Infiltrating-diffuse Extracranial Arteriovenous Malformations in the Head and Neck. Eur J Vasc Endovasc Surg 2015; 50:114-21. [DOI: 10.1016/j.ejvs.2015.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023]
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Surgical Treatment of Extracranial Arteriovenous Malformations after Multiple Embolizations. Plast Reconstr Surg 2015; 135:543-552. [DOI: 10.1097/prs.0000000000000890] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Scalp arteriovenous malformations are an exceptional group of vascular lesions with curious presentations and an elusive natural history. Their detection in the pediatric population is a rarer occurrence. We discuss our experience with five children suffering from this pathology and their surgical management carried at our institution from 2007 to 2013. The genesis in pediatric patients is, usually, spontaneous in contrast with the history of trauma seen in adults. Clinical symptoms, usually, range from an asymptomatic lesion, local discomfort, headaches to necrosis and massive hemorrhage. Selective angiography remains the cornerstone for investigation. Complete surgical excision, embolization or an approach combining the modalities is curative.
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Affiliation(s)
- Rakesh Gupta
- Department of Neurosurgery, SAIMS Medical College and P.G. Institute, Indore, Madhya Pradesh, India
| | - Akshat Kayal
- Department of Neurosurgery, SAIMS Medical College and P.G. Institute, Indore, Madhya Pradesh, India
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13
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Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region. Cardiovasc Intervent Radiol 2014; 38:632-41. [DOI: 10.1007/s00270-014-0993-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/27/2014] [Indexed: 12/27/2022]
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Chowdhury FH, Haque MR, Kawsar KA, Sarker MH, Momtazul Haque AFM. Surgical management of scalp arterio-venous malformation and scalp venous malformation: An experience of eleven cases. Indian J Plast Surg 2013; 46:98-107. [PMID: 23960313 PMCID: PMC3745130 DOI: 10.4103/0970-0358.113723] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims: Scalp arterio-venous malformation (AVM) and scalp venous malformation (SVM) are rare conditions that usually need surgical treatment. Here, we have reported our experience of the surgical management of such lesions with a short review of the literature. Materials and Methods: In this prospective study, 11 patients with scalp AVM and SVM, who underwent surgical excision of lesion in our hospital from 2006 to 2012, were included. All suspected high-flow AVM were investigated with the selective internal and external carotid digital subtraction angiogram (DSA) ± computed tomography (CT) scan of brain with CT angiogram or magnetic resonance imaging (MRI) of brain with MR angiogram, and all suspected low-flow vascular malformation (VM) was investigated with MRI of brain + MR angiogram. Eight were high-flow and three were low-flow VM. Results: All lesions were successfully excised. Scalp cosmetic aspects were acceptable in all cases. There was no major post-operative complication or recurrence till last follow-up. Conclusions: With preoperative appropriate surgical planning, scalp AVM and SVM can be excised without major complication.
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Arterio venous malformation of the face: surgical treatment. J Maxillofac Oral Surg 2011; 14:25-31. [PMID: 25861180 DOI: 10.1007/s12663-011-0270-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE This article reports a case of arteriovenous malformation of the face and upper lip. It discusses the diagnostic aids, surgical treatment and the results obtained. METHODS A vascular malformation with Arterio venous shunts of the left cheek and upper lip was treated by surgical excision in a young 26 year old patient. Ligation of the feeding vessels followed by surgical excision has been discussed. The lesion was approached through modified Weber Fergusson incision with extension into contralateral lip. FOLLOW UP Secondary cosmetic correction was done two months postoperatively. In a one year, there was no recurrence of the arteriovenous malformation with acceptable cosmetic results. CONCLUSIONS A combined treatment including ligation of feeding vessels and surgical excision has been effective and safe in this patient. It was done due to cost factors, and inavailability of embolization facilities.The location and extent of a vascular malformation should dictate the preoperative investigations, surgical procedure and subsequent outcome.
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Cil BE, Vargel I, Geyik S, Peynircioglu B, Cavusoglu T. Venous vascular malformations of the craniofacial region: pre-operative embolisation with direct percutaneous puncture and N-butyl cyanoacrylate. Br J Radiol 2008; 81:935-9. [PMID: 18824500 DOI: 10.1259/bjr/66893325] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Craniofacial venous vascular malformations cause severe cosmetic problems and yet these lesions are not candidates for transcatheter embolisation owing to the lack of arterial feeders. The purpose of this study was to evaluate the effectiveness of pre-operative embolisation of these lesions with N-butyl 2-cyanoacrylate (NBCA) via direct puncture. Between September 2003 and April 2006, 13 patients (7 female; age range, 6-64 years; mean, 16.7 years) were embolised with direct puncture and injection of NBCA. All of the patients were referred from plastic surgery with an operational plan. Angiography performed in all patients showed no or little arterial staining. NBCA diluted with iodized oil at a ratio of 1:6 (18%) was injected via a percutaneously placed 21 gauge needle. Complete embolisation was achieved in 8 patients and partial embolisation in the remaining 5. A total of 18 sessions of embolisation were performed on 13 patients. Nine patients underwent only one embolisation session, three patients underwent two sessions and only one patient underwent three sessions. The mean volume of NBCA used per session was 5.8 ml, ranging from 1-12 ml. All patients underwent a successful surgical resection to improve cosmetic disfigurement within 10-15 days after the embolisation procedure. Mean follow-up time was 22 months. One patient experienced skin necrosis on her nose after embolisation. No other complications related to the procedure were observed. In conclusion, pre-operative NBCA embolisation with direct puncture is a safe and easy procedure. It can increase the success of the surgical treatment of these lesions.
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Affiliation(s)
- B E Cil
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye 06100, Ankara, Turkey.
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Tiwary SK, Khanna R, Khanna AK. Craniofacial Cirsoid Aneurysm: 2-Stage Treatment. J Oral Maxillofac Surg 2007; 65:523-5. [PMID: 17307602 DOI: 10.1016/j.joms.2005.10.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 08/04/2005] [Accepted: 10/31/2005] [Indexed: 10/23/2022]
Affiliation(s)
- Satyendra K Tiwary
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Thornton BP, Sloan D, Rinker B. Squamous Cell Carcinoma Arising from an Arteriovenous Malformation of the Scalp. J Craniofac Surg 2006; 17:805-9. [PMID: 16877939 DOI: 10.1097/00001665-200607000-00038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We present the case of a 70-year-old man with a congenital scalp lesion consistent with an arteriovenous malformation (AVM) which over the last 3 years had developed ulcerative changes and bleeding in the central aspect that was a biopsy proven squamous cell carcinoma (SCCA). To control hemorrhage during surgery, a radiologist performed selective embolization of major feeding arteries in the lesion three days before the surgery. After total resection of the lesion, a scalp reconstruction was performed by using a free latissimus muscle flap and skin graft. As a result, bleeding was well controlled, the AVM and SCCA were totally resected, and satisfactory aesthetic results were obtained. This appears to be the first description of a SCCA arising from a chronic AVM. This is suggestive of a possible Marjolin's ulcer from a chronic wound bed.
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Affiliation(s)
- Brian P Thornton
- Division of Plastic Surgery, University of Kentucky, Lexington Kentucky, USA.
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Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Watanabe A, Ishii R. Free perforator flap for the treatment of defects after resection of huge arteriovenous malformations in the head and neck regions. Ann Plast Surg 2003; 51:194-9. [PMID: 12897525 DOI: 10.1097/01.sap.0000044706.58478.73] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The authors report two cases of huge arteriovenous malformations in the head and neck regions treated successfully with preoperative superselective transarterial embolization and resection followed by a free perforator flap transfer. Based on the authors' previous cases, en block mass resection of the malformation was possible with bleeding of less than 150 ml. The massive defects could be repaired with free perforator flaps using an anterolateral thigh flap and a deep inferior epigastric artery perforator flap. One patient who lost facial muscle underwent reconstruction by simultaneous muscle transfer, and both patients regained acceptable cosmetic appearance and dynamic facial function. Now, more than 4 to 7 years after surgery, the patients have shown no reexpansion of the malformation. The important points of this treatment are complete embolization to accomplish total resection with minimal bleeding, free flap transfer to prevent postoperative reexpansion or recurrence of arteriovenous malformations, and the selection of recipient vessels because of arterial embolization in part of the lesion.
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Affiliation(s)
- Isao Koshima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Dentistry, Okayama University, Okayama, Japan
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