Lixin Su

Absolute Ethanol Sclerotherapy for Venous Malformations in the Face and Neck

PURPOSE The purpose of the present study was to evaluate the outcomes of sclerotherapy using absolute ethanol for venous malformations in the face and neck. PATIENTS AND METHODS We treated 60 consecutive patients with venous malformations in the face and neck with sclerotherapy with absolute ethanol under the guidance of digital subtraction angiography. Magnetic resonance imaging was used to evaluate the clinical outcomes of sclerotherapy. Complications were also evaluated. RESULTS The duration of follow-up was a mean of 8 months (range, 3 to 22). Of the 60 patients, 22 were treated once and 38 were treated 2 to 18 times (mean 2.6 times/patient). The mean total volume of ethanol in 60 patients was 11.2 mL (range, 0.5 to 230 mL). Of the 60 patients, 56 had complete volume reduction and a marked response after treatment. No severe skin necrosis or permanent nerve damage occurred. CONCLUSION Percutaneous sclerotherapy with absolute ethanol under the guidance of venography is a safe and effective treatment for venous malformations in the face and neck.

Propranolol for problematic head and neck hemangiomas: An analysis of 37 consecutive patients

OBJECTIVE Infantile hemangiomas (IHs) on head and neck are frequently encountered. Recently, propranolol was introduced as a novel pharmacologic treatment for IH. But the impact of propranolol for the treatment of IHs especially the side effects have not yet been well described. This article aimed to describe the effects and side effects of propranolol treatment in 37 children with problematic hemangiomas on head and neck. STUDY DESIGN Data were collected from the medical charts of patients treated between October 2008 and November 2010. Serial examinations and photographs were obtained to evaluate perceived therapeutic response and complications of oral propranolol in the course of their therapy. RESULTS Thirty-seven infants with propranolol-treated problematic head and neck hemangiomas were included and all patients had a good response. Most of patients were subjectively noticed an obvious improvement within one week from the onset of therapy. 29 patients endured the treatment of propranolol for 3 months with no recurrence, 6 patients endured prolonged course of treatment for 5/6 months. 2 patients who endured the treatment of propranolol for 3 months were found recurrence in two weeks. So the propranolol was given again for another 3 months. There were no severe adverse reactions. Minor side effects included diarrhea, light sleeping, and nausea. CONCLUSION Propranolol appears to be an effective and well-tolerated treatment for problematic IH on head and neck.

Embolization treatment of pseudoaneurysms originating from the external carotid artery

OBJECTIVE The purpose of this study was to review a single-institution contemporary experience with embolization treatment of pseudoaneurysms (PAs) from the external carotid artery (ECA). METHODS From December 2000 to June 2014, PAs in the head and neck of 17 patients underwent embolization treatment and were retrospectively evaluated. All were treated with obliteration of the feeding artery or the PA by detachable coils or fibered coils, or both. Clinical follow-up was a mean of 91.9 months (range, 4-173 months) and was performed for all patients. Therapeutic outcomes were determined by evaluating the postprocedural image and clinical outcome of symptoms and signs. RESULTS The 17 consecutive patients with head and neck PAs who underwent coils embolization treatment consisted of 14 male patients (82.3%) and three female patients (17.7%). The average age was 37.5 years (range, 16-57 years). The most common symptom and sign was a pulsatile mass, seen in 15 of 17 patients, and other symptoms included pain (three patients) or bleeding (four patients). Digital substraction angiography revealed that the PAs originated from the ECA in 3 patients and others originated from the branches of the ECA, including the superficial temporal artery in 6 patients, internal maxillary artery in 4, superior thyroid artery in 2, and the facial artery and posterior auricular artery in 1. Seventeen coils embolizations for occlusion of the parent artery were performed in 14 patients with a transarterial approach and in three by direct percutaneous puncture. All patients remained symptom free, and no procedure-related complications occurred. CONCLUSIONS Embolization treatment of PAs from the ECA is a useful alternative to standard surgical repair. This modality avoids the necessity for surgical exposure of the face and of the neck with its inherent morbidity.

Ethanol Embolization of Hemophilic Pseudotumor of the Mandible

Hemophilic pseudotumor (HP) is an infrequent complication with an estimated occurrence of 1–2% in severe hemophiliacs [1]. Embolization was mostly described as a presurgical intervention to reduce bleeding. In 1990, Pisco reported a case of HP in the wing of the iliac bone treated successfully with transcatheter arterial embolization [2]. We report a case of HP of the mandible treated by ethanol embolization alone.

Salvage treatment of hemorrhagic arteriovenous malformations in jaws.

OBJECTIVE To present our clinical experience on embolotherapy of arteriovenous malformations (AVMs) in jaws with acute hemorrhage. MATERIALS AND METHODS Twelve patients with a history of hemorrhage were selected for this study. Continuous interdental sling suture, digital pressure on the extraction socket, and iodoform gauze packed into the socket and fixed with sutures to the adjacent gum were used for temporary hemostasis before embolization. Fiberoptic bronchoscopy was used in all cases to facilitate endotracheal intubation. Absolute ethanol combined with coils was used as method of embolization. RESULTS Eight patients presented with intermittent interdental gum bleeding or controlled hemostasis before embolization. Four patients presented with torrential hemorrhage around the tooth, controlled by continuous pressure on the tooth and bilateral gum for temporary hemostasis. All patients were successfully salvaged before embolization. Ten of 12 patients were cured, and 2 had partial remission. Follow-up ranged from 12 to 26 months (mean, 16.5 months) for all patients, and there was no recurrence of the lesions. CONCLUSIONS The treatment of hemorrhagic AVMs of the jaw requires a multidisciplinary team approach; such cases can be successfully salvaged and stably controlled by embolization with coils and absolute ethanol.

Direct intralesional ethanol sclerotherapy of extensive venous malformations with oropharyngeal involvement after a temporary tracheotomy in the head and neck: Initial results

The purpose of this study was to evaluate the safety and efficacy of direct intralesional ethanol sclerotherapy for venous malformations (VMs) with oropharyngeal involvement after a temporary tracheotomy.

Absolute Ethanol Embolization of Infiltrating-diffuse Extracranial Arteriovenous Malformations in the Head and Neck

OBJECTIVE Extracranial arteriovenous malformations (AVMs) of an infiltrative type in the head and neck can cause cosmetic, functional, and psychological problems. This study reports a single center experience and evaluates the clinical safety and effectiveness of the sole use of absolute ethanol embolotherapy for infiltrative extracranial AVMs in the head and neck. METHOD From June 2011 to June 2013, 168 consecutive patients with extracranial AVMs in the head and neck underwent staged ethanol or other methods of embolization, of whom 66 patients had infiltrating-diffuse extracranial AVMs of type III in the head and neck. Absolute ethanol embolization was solely used and retrospectively evaluated. All patients were assessed at clinical follow up (mean 16.8 months; range 12-38 months). Therapeutic outcomes were determined by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization by follow up angiography. RESULTS For the 96 sessions, the mean amount of ethanol used in a single embolization session was 13.6 mL and range was from 2 to 25 mL. Fifty-six of the 66 patients were effectively controlled with 100% of the AVMs devascularized, and the remaining 10 patients had partial remission with various degrees of AVM devascularization (50-99%). Transient hemoglobinuria occurred in five of the 66 patients for a total 16 out of 96 procedures. There were no major complications. CONCLUSIONS The sole use of ethanol embolotherapy appears to be efficacious and safe in the management of infiltrating-diffuse extracranial AVMs in the head and neck.

Absolute Ethanol Embolization Combined with Surgical Resection of Scalp Arteriovenous Malformations: Interim Results

PURPOSE To assess treatment methods, interim results, and complications of absolute ethanol embolization combined with surgical resection of scalp arteriovenous malformations (AVMs). MATERIALS AND METHODS From September 2012 to January 2015, 15 consecutive patients (8 male and 7 female) with scalp AVMs underwent staged ethanol embolizations. Ethanol embolization was performed using transcatheter and/or direct puncture techniques. Ten patients with scalp AVMs with a dominant outflow vein (DOV) also underwent coil deployment before ethanol embolization. Two patients underwent surgical resection after ethanol embolization was achieved. Follow-up evaluations included clinical outcome of symptoms and signs and imaging at 1.5 months, 6 months, and annually thereafter. RESULTS In 15 patients, 33 ethanol embolizations were performed; 16 coil deployments were performed in 10 patients who had scalp AVMs with a DOV. Of 15 patients, 8 (53.3%) were cured, 2 of whom underwent surgical resection. All 8 patients showed no recurrence in the follow-up period (range, 12-48 months; mean, 25 months). Seven patients (46.7%) had partial remission and will need further treatment sessions for residual AVMs (range, 1-12 months; mean, 7 months). In 3 of 15 patients (20%), 7 minor complications (skin blisters and necrosis) occurred. All minor complications healed with wound dressing and observation. There were no major complications. CONCLUSIONS Ethanol embolization has the potential for cure in management of scalp AVMs, with an acceptable risk of minor and major complications. Once AVMs are devascularized, surgical resection can be performed to improve cosmetic results.

Diffusion-Weighted MR Imaging of Unicystic Odontogenic Tumors for Differentiation of Unicystic Ameloblastomas from Keratocystic Odontogenic Tumors

Objective Differentiating unicystic ameloblastomas from keratocystic odontogenic tumors (KCOT) is necessary for the planning of different treatment strategies; however, it is difficult based on conventional CT and MR sequences alone. The purpose of this study was to investigate the utility of diffusion-weighted imaging (DWI) and apparent diffusion coefficients (ADCs) in the differentiation of the two tumors. Materials and Methods We prospectively studied 40 patients with odontogenic cysts and tumors of the maxillomandibular region using conventional MR imaging and DWI. ADCs were measured using 2 b factors (500 and 1000). Results Unicystic ameloblastomas (n = 11) showed free diffusion on DWI and a mean ADC value of 2.309 ± 0.17 × 10-3 mm2/s. KCOT (n = 15) showed restricted diffusion on DWI with a mean ADC value of 0.923 ± 0.20 × 10-3 mm2/s. The ADC values of unicystic ameloblastomas were significantly higher than those of KCOT (p < 0.001, Mann-Whitney U-test). An ADC cut-off value of 2.0 × 10-3 mm2/s to differentiate KCOT and unicystic ameloblastomas resulted in a 100% sensitivity and 100% specificity. Dentigerous cysts (n = 3) showed restricted diffusion on DWI and similar ADC values (1.257 ± 0.05 × 10-3 mm2/s) to those of KCOT. Conclusion Diffusion-weighted imaging and ADC determination can be used as an adjuvant tool to differentiate between unicystic ameloblastomas and KCOT, although the ADC values of dentigerous cysts overlap with those of KCOT.