Direct Puncture of Large Arteriovenous Malformations in Head and Neck for Embolisation and Subsequent Reconstructive Surgery

Abstract

Five patients with large arteriovenous malformations (AVM) of the head and neck, which were too large or inconveniently placed for operation alone, were treated by embolisation after direct puncture; two of them were subsequently operated upon. They all recovered without complications. Embolisation of the nidus and subsequent operation is a good alternative for the treatment of large AVM. Ligating the supplying arteries is not a treatment. If the arterial routes to the nidus have previously been closed by ligatures selective catheterisation is impossible, though direct puncture of the nidus is a possibility. The nidus of the AVM can then be obliterated by embolisation either as a treatment, or as a preoperative procedure.

Evolving Experience With Direct Puncture Therapeutic Embolization for Adjunctive and Palliative Management of Head and Neck Hypervascular Neoplasms

“…In recognizing these problems, an unconventional alternative approach to devascularization of craniofacial tumors has been recently described, simply referred to as direct puncture tumor embolization (DPTE) 4 . This technique, which was partially based on prior descriptions of direct puncture of osseous spinal tumors, 5,6 superficial high‐ and low‐flow vascular malformations, 7,8 and certain visceral neoplasms, 9‐11 involves percutaneous placement of a needle directly within the neoplasm, through which certain liquid embolic agents (e.g., cyanoacrylate suspensions or absolute ethanol) are injected into the tumor neovasculature after confirmation by test injection of contrast media.…”

Arteriovenous malformation of the nasopharynx: A case report

“…As AVM has the gradual onset and progression, it is rarely associated with an enlarged heart and high output cardiac failure [12]. There are series of cases reported by authors [13][14][15][16][17] but one of the largest series was reported by Kohout et al [12]. He reported 81 AVM located in head and neck area.…”

Arteriovenous Malformation Pinna: Review of Literature

“…8 Surgical ligation of proximal feeding vessels should be avoided, as it not only aggravates the lesion by establishing new collaterals but also precludes later embolization. 9 Proximal embolization also leads to failure for the same reasons. 10 Embolization alone can be used for palliation of the lesions located in difficult to approach areas or very close to vital structures.…”

“…10 Embolization alone can be used for palliation of the lesions located in difficult to approach areas or very close to vital structures. 9 In such cases, stroke, cranial nerve palsy and blindness-like complications can occur. 11 Total resection which requires a wide field resection of all the involved tissue is necessary to prevent recurrence; however, cosmetic and functional issues might limit the extent to which tissue can be removed.…”