Sclerotherapy for lymphatic malformations of head and neck: Systematic review and meta-analysis

Maria, Lucio De; Sanctis, Paolo De; Balakrishnan, Karthik; Tollefson, Megha M.; Brinjikji, Waleed

doi:10.1016/j.jvsv.2019.09.007

Cited by 41 publications

(38 citation statements)

References 31 publications

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“…29 A recent systematic review of percutaneous sclerotherapy by de Maria et al reported overall rates of permanent morbidity and mortality of 1.2% and local transient complication, such as skin injury, of 14.0%. 30 Higher complication rates have been reported in the management of microcystic lesions. 30…”

Section: Sclerotherapymentioning

confidence: 99%

“…32,33 Multiple studies have touted doxycycline as superior to multiple other sclerosing agents with success rates of 79 to 100%. 30,[33][34][35] Side effects include hemolytic anemia and metabolic acidosis in neonates as well as tooth discoloration and skin ulceration/necrosis if extravasation occurs. 6 Due to the side effect profile, many institutions limit single-session doses to 150 mg in neonates, 300 mg in infants <12 months and 1,200 mg in all other patients with typical concentrations ranging from 10 to 20 mg/mL reconstituted in a combination of sterile water and iodinated contrast.…”

Section: Doxycyclinementioning

confidence: 99%

“…54,55 Side effects include fever, pain, edema, and rarely anaphylaxis, and systemic side effects are reported at higher rates than other sclerosants. 30,38 Since institutional review board approval is needed to use OK-432, and its efficacy is not superior to other sclerosants; its use in the United States is limited. 56…”

Section: Ok-432mentioning

confidence: 99%

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The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

Cronan

Gill

Shah

et al. 2020

Semin intervent Radiol

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Lymphatic malformations are low-flow vascular malformations that are typically apparent in the pediatric population and can cause significant functional limitations and effects on quality of life. While surgical resection has historically been the mainstay of therapy, percutaneous sclerotherapy has garnered increasing popularity due to its efficacy and low complication rates. The role of interventional radiology in the multidisciplinary management of these often complex malformations requires thorough understanding of the disease process. This article will review the pathophysiology, clinical presentation, imaging workup, and management options of lymphatic malformations. Special attention will be devoted to available sclerosants, the mammalian target of rapamycin inhibitor sirolimus, and complex lymphatic anomalies.

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Section: Sclerotherapymentioning

confidence: 99%

Section: Doxycyclinementioning

confidence: 99%

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The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

Cronan

Gill

Shah

et al. 2020

Semin intervent Radiol

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“…Different characteristics such as size, site, depth, association with adjacent structures, and the composition of a lesion should be considered before active treatment is started. 52,53 Initial therapy is based on the prevention of complications with medical treatment. For example, elastic compression is used for prevention of venous stasis, but it is used in the truncular forms only, whereas therapy with low-molecularweight heparin is recommended in all the cases characterized by flow stagnation or thrombosis.…”

Section: Vascular Malformationsmentioning

confidence: 99%

“…It is well tolerated by patients with few complications, and it is a simple, fast, and inexpensive technique. 53 Different sclerosant agents may be used. Ethanol has proved to be the most powerful sclerosing agent but also the one with the highest toxicity and complication rates, along with the most severe side effects.…”

Section: Vascular Malformationsmentioning

confidence: 99%

Musculoskeletal Interventional Radiology in the Pediatric Population: State of the Art

Arrigoni

Izzo

Bruno

et al. 2021

Semin Musculoskelet Radiol

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Interventional radiology procedures have been proven to be as effective as traditional surgery but usually are characterized by lower morbidity rates. In this article, the most diffuse IR treatments for pediatric lesions are reviewed with the aim of describing main advantages and drawbacks. Ablation procedures (in particular RFA and MRgFUS) are widely used for the management of osteoid osteoma and osteoblastoma whereas intracystic injection of methylprednisolone acetate is performed for simple bone cysts. Sclerosing agents and where possible, selective arterial embolization are used for treatment of aneurysmal bone cysts and other vascular malformations. In the management of malignant muscoloskeletal tumors, the role interventional radiology is mainly represented by percutaneous biopsies, and by adiuvant selective embolizations in presence of hypervascular lesions to be submitted to surgery.

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Sirolimus (Rapamycin) for Slow-Flow Malformations in Children

et al. 2021

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IMPORTANCESirolimus is increasingly being used to treat various vascular anomalies, although evidence of its efficacy is lacking.OBJECTIVE To assess the efficacy and safety of sirolimus for children with slow-flow vascular malformations to better delineate the indications for treatment. DESIGN, SETTING AND PARTICIPANTSThis multicenter, open-label, observational-phase randomized clinical trial included 59 children aged 6 to 18 years with a slow-flow vascular malformation who were recruited between September 28, 2015, and March 22, 2018, in 11 French tertiary hospital centers. Statistical analysis was performed on an intent-to-treat basis from December 4, 2019, to November 10, 2020.INTERVENTIONS Patients underwent an observational period, then switched to an interventional period when they received oral sirolimus (target serum levels, 4-12 ng/mL). The switch time was randomized from month 4 to month 8, and the whole study period lasted 12 months for each patient. MAIN OUTCOMES AND MEASURESThe primary outcome was change in the volume of vascular malformations detected on magnetic resonance imaging scan (with centralized interpretation) per unit of time (ie, between the interventional period and the observational period). Secondary outcomes included subjective end points: pain, bleeding, oozing, quality of life, and safety. RESULTS Among the participants (35 girls [59.3%]; mean [SD] age, 11.6 [3.8] years), 22 (37.3%) had a pure venous malformation, 18 (30.5%) had a cystic lymphatic malformation, and 19 (32.2%) had a combined malformation, including syndromic forms. Variations in the volume of vascular malformations detected on magnetic resonance imaging scans associated with the duration period were not overall significantly different between the interventional period and the observational period (all vascular malformations: mean [SD] difference, -0.001 [0.007]; venous malformations: mean [SD] difference, 0.001 [0.004]; combined malformations: mean [SD] difference, 0.001 [0.009]). However, a significant decrease in volume was observed for children with pure lymphatic malformations (mean [SD] difference, -0.005 [0.005]). Overall, sirolimus had positive effects on pain, especially for combined malformations, and on bleeding, oozing, self-assessed efficacy, and quality of life. During sirolimus treatment, 56 patients experienced 231 adverse events (5 serious adverse events, none life-threatening). The most frequent adverse event was an oral ulcer (29 patients [49.2%]).CONCLUSIONS AND RELEVANCE This observational-phase randomized clinical trial allows for clarifying the goals of patients and families when starting sirolimus therapy for children older than 6 years. Pure lymphatic malformations seem to be the best indication for sirolimus therapy because evidence of decreasing lymphatic malformation volume per unit of time, oozing, and bleeding and increasing quality of life was found. In combined malformations, sirolimus significantly reduced pain, oozing, and bleeding. Benefits seemed lower for pure venous malformation...

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Sclerotherapy for lymphatic malformations of head and neck: Systematic review and meta-analysis

Cited by 41 publications

References 31 publications

The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

Musculoskeletal Interventional Radiology in the Pediatric Population: State of the Art

Sirolimus (Rapamycin) for Slow-Flow Malformations in Children

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