1
|
Ho RW, Nonnenmacher G, Henkes H, Vokuhl C, Loff S. A multi-step approach to the treatment of giant scalp congenital hemangiomas: a report of two cases. Front Surg 2023; 10:1045285. [PMID: 37292488 PMCID: PMC10244559 DOI: 10.3389/fsurg.2023.1045285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/12/2023] [Indexed: 06/10/2023] Open
Abstract
This is a review of two cases of neonatal giant scalp congenital hemangioma. Both patients were treated with propranolol using a similar multi-step approach that included transarterial embolization of the supplying arteries followed by surgical resection of the lesion. In this report, we discuss the treatments, complications, and clinical outcomes of interventions and surgical procedures.
Collapse
Affiliation(s)
- Raymond W. Ho
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Gabriel Nonnenmacher
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Katherinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Steffan Loff
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| |
Collapse
|
2
|
Alluhaybi AA, Abdulqader SB, Altuhayni K, AlTurkstani A, Kabbani A, Ahmad M. Preoperative trans-arterial embolization of a giant scalp congenital hemangioma associated with cardiac failure in a premature newborn. J Int Med Res 2021; 48:300060520977589. [PMID: 33296609 PMCID: PMC7731708 DOI: 10.1177/0300060520977589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Scalp congenital hemangiomas are a rare, but well-known, vascular malformation in infants. These hemangiomas are usually benign, but occasionally these are associated with cardiac complications and disfigurement. Giant hemangiomas that are associated with high-output heart failure require intervention because they have a high mortality rate and do not respond to medical therapy. We report here a case of a premature newborn who was diagnosed with a giant scalp hemangioma associated with cardiac failure. The newborn underwent successful arterial feeder embolization of the superficial temporal artery. He then underwent surgical excision 14 days after embolization. We believe that preoperative embolization of a giant scalp hemangioma in newborns is a safe measure for alleviating underlying cardiac failure and minimizing the risk of intraoperative bleeding.
Collapse
Affiliation(s)
- Abdulelah A Alluhaybi
- Pediatric Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sarah Bin Abdulqader
- Pediatric Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Altuhayni
- Pediatric Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulellah AlTurkstani
- Pediatric Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aseel Kabbani
- Pediatric Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Maqsood Ahmad
- Pediatric Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Verma S, Dhamija E, Barwad A, Kumar VS, Rastogi S. A case report of Kaposiform haemangioendothelioma; response with propranolol and steroids. Clin Sarcoma Res 2020; 10:12. [PMID: 32765826 PMCID: PMC7394668 DOI: 10.1186/s13569-020-00134-8] [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: 01/20/2020] [Accepted: 07/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background Kaposiform haemangioendothelioma is a rare vascular tumor and may involve skin, deep soft tissue or bone. It is a locally aggressive tumor usually seen in infants. Here we report a case of kaposiform hemagioendothelioma in a child who responded to propranolol and steroids. Case presentation A 3-year-old male child presented with a swelling below his right knee with characteristic violet skin lesion. There was no evidence of Kasabach–Merritt phenomenon. After no improvement with several attempts at debridement and anti-tubercular treatment; a diagnosis of Kaposiform Haemangioendothelioma was reached on the basis of overall clinical picture and histology. The child was treated with propranolol and steroids and had an excellent clinical response and a near complete resolution on imaging at 5 months. Conclusions These cases are often misdiagnosed and despite a delay in diagnosis have good outcomes with appropriate multimodality management. This case highlights the unique and typical characteristics of kaposiform haemangioendothelioma.
Collapse
Affiliation(s)
- Saurav Verma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatesan S Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Sarcoma Medical Oncology Clinic, Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Khant ZA, Hirai T, Ikeda O, Furukoji E, Kadota Y, Azuma M, Shinkawa N, Kitatani K, Mizutani Y, Endo K, Yamashita Y. Successful transarterial embolization with cellulose porous beads for occipital haemangioma in an infant with Kasabach-Merritt syndrome. BJR Case Rep 2017; 3:20170004. [PMID: 30363243 PMCID: PMC6159188 DOI: 10.1259/bjrcr.20170004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/26/2017] [Indexed: 11/15/2022] Open
Abstract
We report a 3-month-old boy with Kasabach-Merritt Syndrome (KMS) with an occipital haemangioma who underwent successful transarterial embolization (TAE) with cellulose porous beads (CPBs). As his response to steroids and coil embolization was inadequate, we performed TAE with CPBs, carefully preventing their migration via dangerous anastomoses. The tumour blush decreased, there were no complications, all coagulation tests were immediately normalized and the tumor size decreased gradually. TAE with CPBs is useful for the treatment of KMS.
Collapse
Affiliation(s)
- Zaw Aung Khant
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshinori Hirai
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Osamu Ikeda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiji Furukoji
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoshihito Kadota
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Minako Azuma
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Norihiro Shinkawa
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Keiji Kitatani
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoichi Mizutani
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kimihiko Endo
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
5
|
Khan IS, Kiehna EN, Satti KF, Ehtesham M, Ghiassi M, Singer RJ. Surgical management of large scalp infantile hemangiomas. Surg Neurol Int 2014; 5:41. [PMID: 24818048 PMCID: PMC4014822 DOI: 10.4103/2152-7806.129560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background: Infantile Hemangiomas (IH) are the most common benign tumor of infancy, occurring in over 10% of newborns. While most IHs involute and never require intervention, some scalp IHs may cause severe cosmetic deformity and threaten tissue integrity that requires surgical excision. Case Description: We present our experience with two infants who presented with large scalp IH. After vascular imaging, the patients underwent surgical resection of the IH and primary wound closure with excellent cosmetic outcome. We detail the surgical management of these cases and review the relevant literature. Conclusion: In some cases the IHs leave behind fibro-fatty residuum causing contour deformity. Surgery is often required for very large lesions causing extensive anatomical and/or functional disruption. The goal of surgical intervention is to restore normal anatomic contour and shape while minimizing the size of the permanent scar.
Collapse
Affiliation(s)
- Imad S Khan
- Division of Neurosurgery, Geisel School of Medicine at Dartmouth, Lebanon NH, USA
| | - Erin N Kiehna
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Komal F Satti
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon NH, USA
| | - Moneeb Ehtesham
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville TN, USA
| | - Mahan Ghiassi
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville TN, USA
| | - Robert J Singer
- Division of Neurosurgery, Geisel School of Medicine at Dartmouth, Lebanon NH, USA
| |
Collapse
|
6
|
Srinivasan KG, Vidyadharan R, Patel N, Khan A, McCafferty I, Monaghan A, Lamin S, Nishikawa H. Embolisation of high flow extracranial/peripheral arteriovenous malformations (AVMs) with ethylene vinyl alcohol copolymer (ONYX®) in children—Birmingham Children’s Hospital experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-013-0900-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
|
8
|
Drolet BA, Trenor CC, Brandão LR, Chiu YE, Chun RH, Dasgupta R, Garzon MC, Hammill AM, Johnson CM, Tlougan B, Blei F, David M, Elluru R, Frieden IJ, Friedlander SF, Iacobas I, Jensen JN, King DM, Lee MT, Nelson S, Patel M, Pope E, Powell J, Seefeldt M, Siegel DH, Kelly M, Adams DM. Consensus-derived practice standards plan for complicated Kaposiform hemangioendothelioma. J Pediatr 2013; 163:285-91. [PMID: 23796341 DOI: 10.1016/j.jpeds.2013.03.080] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/22/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Beth A Drolet
- Departments of Pediatrics and Dermatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Lee JH, Roychowdhury S, Nissenblatt MJ. Neuroembolization of metastatic Merkel cell cancer to the face for treatment of Kasabach-Merritt syndrome. J Neurointerv Surg 2013; 6:e3. [PMID: 23385004 DOI: 10.1136/neurintsurg-2012-010556.rep] [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: 11/03/2022]
Abstract
Kasabach-Merritt syndrome is defined as a consumptive thrombocytopenia in the presence of a highly vascular tumor. Multiple treatment options, including transarterial embolization, have been described. We demonstrate that transarterial embolization is a viable option in the treatment of a rapidly progressive and debilitating Merkel cell tumor metastasizing to the head and neck presenting with Kasabach-Merritt syndrome.
Collapse
Affiliation(s)
- Jason Huang Lee
- Department of Radiology, UMDNJ Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | | | | |
Collapse
|
10
|
Lee JH, Roychowdhury S, Nissenblatt MJ. Neuroembolization of metastatic Merkel cell cancer to the face for treatment of Kasabach-Merritt syndrome. BMJ Case Rep 2013; 2013:bcr-2012-010556. [PMID: 23329724 DOI: 10.1136/bcr-2012-010556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kasabach-Merritt syndrome is defined as a consumptive thrombocytopenia in the presence of a highly vascular tumor. Multiple treatment options, including transarterial embolization, have been described. We demonstrate that transarterial embolization is a viable option in the treatment of a rapidly progressive and debilitating Merkel cell tumor metastasizing to the head and neck presenting with Kasabach-Merritt syndrome.
Collapse
Affiliation(s)
- Jason Huang Lee
- Department of Radiology, UMDNJ Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | | | | |
Collapse
|
11
|
Ashour R, Aziz-Sultan MA, Soltanolkotabi M, Schoeneman SE, Alden TD, Hurley MC, Dipatri AJ, Tomita T, Elhammady MS, Shaibani A. Safety and Efficacy of Onyx Embolization for Pediatric Cranial and Spinal Vascular Lesions and Tumors. Neurosurgery 2012; 71:773-84. [DOI: 10.1227/neu.0b013e3182648db6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Although Onyx is widely used to embolize vascular lesions in adults, the safety and efficacy of this liquid embolic agent for use in children are not well studied.
OBJECTIVE:
To report our experience using Onyx in pediatric patients for a variety of cranial and spinal vascular lesions and tumors to determine its procedural complication rates, types, and clinical consequences and to highlight the indications for and principles of Onyx embolization in pediatric patients.
METHODS:
All pediatric Onyx embolization cases performed consecutively by the neuroendovascular services at our 2 institutions over a 5-year period were collected retrospectively and analyzed.
RESULTS:
Over the study period, 105 Onyx embolization procedures were performed in 69 pediatric patients with a mean follow-up of 112 days. Fifty-two patients harbored “primary” vascular lesions (malformations, fistulas, etc), whereas 17 patients had tumors. Complications occurred in 25 of 105 procedures (23.8%) and included ischemic infarct (7), asymptomatic nontarget embolization (4), intracerebral hemorrhage (3), microcatheter-related vessel perforation (3), retained microcatheter (2), cerebral edema (2), dimethyl sulfoxide-induced pulmonary edema (2), facial ischemia (1), and contrast-induced bronchospasm (1). Neurological morbidity occurred transiently after 10 procedures (9.5%) and permanently after 2 procedures (1.9%). There were no procedure-related deaths. Statistical analysis revealed no predictors of complications among the multiple potential risk factors evaluated.
CONCLUSION:
Our experience suggests that Onyx can be used effectively for embolization of pediatric cranial and spinal vascular lesions and tumors with low permanent morbidity; however, attention must be paid to the technical nuances of and indications for its use to avoid potential complications.
Collapse
Affiliation(s)
- Ramsey Ashour
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Mohammad Ali Aziz-Sultan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Maryam Soltanolkotabi
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samantha E. Schoeneman
- Department of Medical Imaging, Children's Memorial Hospital, Children's Memorial Hospital, Chicago, Illinois
| | - Tord D. Alden
- Division of Neurosurgery, Children's Memorial Hospital, Chicago, Illinois
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael C. Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arthur J. Dipatri
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Neurosurgery, Children's Memorial Hospital, Chicago, Illinois
| | - Tadanori Tomita
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Neurosurgery, Children's Memorial Hospital, Chicago, Illinois
| | - Mohamed Samy Elhammady
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Shaibani
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
12
|
Radhi M, Carpenter SL. Thrombotic microangiopathies. ISRN HEMATOLOGY 2012; 2012:310596. [PMID: 22888446 PMCID: PMC3410315 DOI: 10.5402/2012/310596] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 06/10/2012] [Indexed: 01/13/2023]
Abstract
Thrombotic microangiopathy results from thrombotic occlusion of the microvasculature leading to fragmentation of red blood cells, profound thrombocytopenia, and a microangiopathic hemolytic anemia with elevation of lactate dehydrogenase and negative direct Coomb's test. This constellation of clinical and laboratory findings is not due to one disease entity; rather, it represents a variety of underlying diagnoses. Among the major disease entities are TTP/HUS, which can be congenital or acquired, bacterial infections, medications, vascular or endothelial pathology like Kasabach-Merritt phenomenon, and stem cell transplantation. In this paper, we offer a review of some of the major causes of thrombotic microangiopathy.
Collapse
Affiliation(s)
- Mohamed Radhi
- Pediatric Hematology/Oncology/Stem Cell Transplant, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | | |
Collapse
|
13
|
Garcia-Monaco R, Giachetti A, Peralta O, Napoli N, Lobos P, Gioseffi L, Mariani G. Kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon: successful treatment with embolization and vincristine in two newborns. J Vasc Interv Radiol 2012; 23:417-22. [PMID: 22365299 DOI: 10.1016/j.jvir.2011.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/06/2011] [Accepted: 12/08/2011] [Indexed: 11/26/2022] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor and has a high mortality in newborns when associated with Kasabach-Merritt syndrome (KMS). In two newborns with KHE and severe KMS refractory to medical treatment, emergency embolization led to clinical improvement in the acute neonatal setting by reducing tumor volume, increasing the platelet count, and improving other clotting parameters. Systemic vincristine treatment was added for further tumor control. Both patients remained symptom-free at long-term follow-up.
Collapse
Affiliation(s)
- Ricardo Garcia-Monaco
- Vascular Anomalies Center, Hospital Italiano, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina.
| | | | | | | | | | | | | |
Collapse
|
14
|
Subtotal splenic embolization is a safe and effective treatment for isolated splenic vascular tumors associated with consumptive coagulopathy. J Pediatr Hematol Oncol 2011; 33:383-6. [PMID: 21606851 PMCID: PMC3120923 DOI: 10.1097/mph.0b013e3182172515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Consumptive coagulopathy is a known complication of large vascular tumors. We describe 2 episodes of consumptive coagulopathy in young children, which were secondary to isolated splenic vascular tumors. One child was successfully treated by subtotal embolization of the spleen, whereas the second child required splenectomy after an initial embolization improved--but did not fully control--his consumptive coagulopathy.
Collapse
|
15
|
ENOMOTO Y, YOSHIMURA S, EGASHIRA Y, IWAMA T. Transarterial Embolization for Cervical Hemangioma Associated With Kasabach-Merritt Syndrome -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:375-8. [DOI: 10.2176/nmc.51.375] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yukiko ENOMOTO
- Department of Neurosurgery, Gifu University Graduate School of Medicine
| | | | - Yusuke EGASHIRA
- Department of Neurosurgery, Gifu University Graduate School of Medicine
| | - Toru IWAMA
- Department of Neurosurgery, Gifu University Graduate School of Medicine
| |
Collapse
|
16
|
Blei F. Literature Watch. Lymphat Res Biol 2009. [DOI: 10.1089/lrb.2009.7403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|