Korean J Radiol.  2009 Jun;10(3):269-276. 10.3348/kjr.2009.10.3.269.

Ethanol Sclerotherapy for the Management of Craniofacial Venous Malformations: the Interim Results

• Lee IH
• Kim KH
• Jeon P
• Byun HS
• Kim HJ
• Kim ST
• Kim YW
• Kim DI
• Choi JY

• KMID: 1779454
• DOI: http://doi.org/10.3348/kjr.2009.10.3.269

Abstract

OBJECTIVE
We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs). MATERIALS AND METHODS: From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients. RESULTS: A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcomes. Ethanol sclerotherapy was considered effective for 60 patients. All the minor complications such as bulla (n = 5) healed with only wound dressing and observation. Any major complication such as skin necrosis did not develop. CONCLUSION: Percutaneous ethanol sclerotherapy is an effective, safe treatment for CVMs.

Keyword

Ethanol; Head and Neck; Sclerotherapy; Venous malformations

MeSH Terms

Adolescent
Adult
Aged
Analgesics/administration & dosage
Anti-Infective Agents, Local/adverse effects/*therapeutic use
Child
Child, Preschool
Craniofacial Abnormalities/*therapy
Ethanol/adverse effects/*therapeutic use
Feasibility Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pain/drug therapy/etiology
Retrospective Studies
Sclerosing Solutions/adverse effects/therapeutic use
Sclerotherapy/adverse effects/*methods
Treatment Outcome
Vascular Malformations/*therapy
Young Adult

Figure

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  Fig. 1 5-year-old-girl with venous malformation in right cheek. A. Coronal T2 weighted image shows venous malformation (arrow) in right cheek. B. Direct puncture venography shows opacification of venous malformation. C. Coronal T2 weighted image obtained after two sessions of sclerotherapy with ethanol reveals significant shrinkage of venous malformation (arrow).

• 

  Fig. 2 5-year-old-boy with venous malformation in right temporalis muscle. A. Fat suppression axial T2 weighted image demonstrates presence of venous malformation (arrow) with phlebolithes (arrowheads) in right temporalis muscle. B. Direct puncture venography shows opacification of venous malformation. C. Fat suppression axial T2 weighted image obtained after one session of sclerotherapy shows significant shrinkage of venous malformation (arrow) in right temporalis muscle.

• 

  Fig. 3 16-year-old-man with venous malformation involving tongue, lower face and left parapharyngeal space. A. Clinical appearance of soft tissue mass that is located in patient's left cheek. B. Direct puncture venography shows opacification of venous malformation. C. Near-complete shrinkage of venous malformation was obtained with three sessions of sclerotherapy.

• 

  Fig. 4 36-year-old woman with venous malformation in left cheek. A. Fat suppression axial T2 weighted image demonstrates presence of venous malformation (arrow) in left cheek. B. Direct puncture venography shows opacification of venous malformation. C. Fat suppression axial T2 weighted image obtained after two sessions of sclerotherapy shows 50% shrinkage of venous malformation (arrow) in left cheek.

• 

  Fig. 5 15-year-old man with venous malformation involving tongue, lower face and left parapharyngeal space. A. Fat suppression axial T2 weighted image demonstrates presence of venous malformation (arrows) involving tongue, lower face and left parapharyngeal space. B. Direct puncture venography shows opacification of venous malformation. C. Fat suppression axial T2 weighted image obtained after nine sessions of sclerotherapy shows no significant change of venous malformation involving tongue and lower face.

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