Management of Head and Neck Arteriovenous Malformations - Team work Counts

Panda, Naresh K.; Thakur, Prabhat; Sharma, Ramesh Kumar; Biswas, Gautam; Verma, Roshan; Khandelw, Niranjan

doi:10.19104/jors.2016.114

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…And now the results with embolic agents like Onyx. Close monitoring of malformations as in the treatment of malignancies is therefore necessary (10). There are several evidences in the literature confirming the efficacy of combined treatment as in our case.…”

Section: Discussionsupporting

confidence: 70%

Multidisciplinary Approach to Treatment of High Flow Head and Neck Arteriovenous Malformations: Single Centre Experience in 7 Complex Cases

Sudiro¹,

Akhlaque

Uddin

et al. 2022

CVNS

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Introduction: The objective of this work is to determine the role of a multidisciplinary approach in treating the complex high flow head and neck arteriovenous malformations (AVMs), involving radiologists and plastic surgeons for the best possible outcomes. Methods: Between 2018 and 2020, the investigators conducted a retrospective analysis on seven patients with high-flow head and neck AVMs who received treatment at a tertiary care facility. Age at first diagnosis, presenting features, prior therapies, endovascular treatment, surgical treatment, and therapeutic outcomes were all recorded. A comparison of pre-and post-procedure pictures was made to assess the clinical outcomes for all patients. Results: Seven patients with complex high flow head and neck AVMs were jointly managed by performing plastic surgery and interventional radiology. There were male and female, with an average age of 24 years. Each patient underwent embolization followed by surgical resection within a 24-hour window of up to 72 hours. In six out of seven patients, the lesion was removed therapeutically, whereas the seventh required palliative resection. Only one patient, there was a minor wound healing difficulty able to be treated with dressings. Conclusion: The results revealed that embolization alone is not effective to reduce the adverse effects. Incomplete removal of AVM showed the same effect as incomplete removal of a tumour. It may not improve symptoms and may worsen the recurrence, thus multi-modality approach is beneficial. A multidisciplinary approach, aided by the interventional radiologist and enable plastic surgeons to remove the high-flow AVMs effectively.

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Section: Discussionsupporting

confidence: 70%

Multidisciplinary Approach to Treatment of High Flow Head and Neck Arteriovenous Malformations: Single Centre Experience in 7 Complex Cases

Sudiro¹,

Akhlaque

Uddin

et al. 2022

CVNS

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“…As an alternative to minimally invasive techniques, such as SRS and embolization, microsurgical resection can also be proposed [30]. As an example, Panda et al [31] reported 12 patients with head and neck AVMs, with 10 undergoing embolization which was followed by surgery. Complete excision was achieved in 8 cases while partial resection was achieved in 2 cases; 3 patients had complications while being treated (the most common were pain, bleeding, and failure of the reconstruction flap requiring revision surgery) [31].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Gamma Knife Radiosurgery for Extracranial Arteriovenous Malformations

Dedeciusová

Tuleasca

Hajdu³

et al. 2020

Stereotact Funct Neurosurg

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Introduction: Head and neck extracranial arteriovenous malformations (AVMs) are rare pathological conditions which pose diagnostic and reconstruction challenges. Stereotactic radiosurgery (SRS) is nowadays an established treatment method for brain AVMs, with high obliteration and low complication rates. Here we describe the first report of head extracranial AVMs successfully treated by Gamma Knife (GK) as a retrospective historical cohort. Methods: Over a 9-year period, 2 cases of extracranial AVMs were treated by GK Perfexion (Elekta Instruments AB, Stockholm, Sweden) at a single institution. A stereotactic frame and multimodal imaging, including digital subtraction angiography (DSA), were used. The prescribed dose was 24 Gy at the 50% isodose line. Results: The first case was of a patient with pulsating tinnitus and left superficial parotido-condylian AVM. Embolization achieved partial obliteration. Tinnitus disappeared during the following 6 months after GK. The second case was a patient with repetitive gingival hemorrhages and right superior maxillary AVM, fed by the right internal maxillary and facial arteries. Embolization achieved partial obliteration with recurrence of symptoms. GK was further performed. DSA confirmed complete obliteration in both patients. Conclusions: Single-fraction GK radiosurgery appears to be safe and effective for extracranial AVMs. We recommend prescribing doses that are comparable to the ones used for brain AVMs (i.e., 24 Gy). A stereotactic frame is an important tool to ensure higher accuracy in the context of these particular locations. However, in selected cases, a mask could be applied either for single fraction purposes (if in a non-mobile location) or for hypofractionation, in case of larger volumes. These findings should be validated in larger cohorts, inclusively in terms of dose prescription.

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Management of Head and Neck Arteriovenous Malformations - Team work Counts

Cited by 2 publications

References 10 publications

Multidisciplinary Approach to Treatment of High Flow Head and Neck Arteriovenous Malformations: Single Centre Experience in 7 Complex Cases

Multidisciplinary Approach to Treatment of High Flow Head and Neck Arteriovenous Malformations: Single Centre Experience in 7 Complex Cases

Stereotactic Gamma Knife Radiosurgery for Extracranial Arteriovenous Malformations

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