Vascular Lesions

Abstract

Classification of vascular lesions based of off the biological behavior has greatly facilitated more accurate diagnoses, optimally defined treatment plans, and better outcomes. Treatment of vascular lesions has taken a more conservative surgical approach with reliance on select medical treatment options, which has greatly reduced morbidity and mortality resulting from extensive surgery. A multidisciplinary approach involving multiple surgical and pediatric subspecialties has led to advancement in both understanding and ideal treatment strategies of these lesions.

Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection

“…10 Articles cited in the Introduction herein have generally reported that the risk of facial nerve injury is 5% to 10% for treatment of vascular anomaly in the cervicofacial region. [1][2][3][4] The reason for dramatically improved facial nerve outcomes is in part explained by the FNM but also because the FNM enables (1) improved planning for an approach that has potentially less collateral tissue damage and (2) focused concentration by the surgeon, with confidence in the intraoperative interrogations of the nerve, as reported by the neurophysiologist.…”

“…Surgical treatment of cervicofacial vascular anomalies is challenging due to malformation location, vascularity, and risk to surrounding structures, particularly the often elongated, displaced branches of the facial nerve. Compared with parotidectomy, the incidence of facial nerve injury for treatment of vascular malformations is higher, reported at 9% compared with 5% . Other treatment modalities, including sclerotherapy, are not without risk to the branches of the facial nerve, and injury rates can be higher than with surgical excision, especially in the region of the zygomatic branch .…”

“…A recent systematic review and meta-analysis of parotidectomy surgery showed no significant long-term nerve outcome improvement using the device. It is known that facial nerve anatomy can be significantly altered in association with facial vascular anomalies, creating increased risk of nerve injury and lifelong morbidity when facial vascular lesions are treated with invasive therapy …”

“…Compared with parotidectomy, the incidence of facial nerve injury for treatment of vascular malformations is higher, reported at 9% compared with 5%. 1,2 Other treatment modalities, including sclerotherapy, are not without risk to the branches of the facial nerve, and injury rates can be higher than with surgical excision, especially in the region of the zygomatic branch. 3,4 Although it is understood that the risk of posttreatment facial nerve dysfunction is high after vascular anomaly treatment, particularly lymphatic malformations, facial nerve functional outcomes have not been consistently reported, and now the importance of including these outcomes in treatment reports is recognized.…”

“…It is known that facial nerve anatomy can be significantly altered in association with facial vascular anomalies, creating increased risk of nerve injury and lifelong morbidity when facial vascular lesions are treated with invasive therapy. 1,2 To reduce the risk of facial nerve injury and dysfunction, a more sophisticated form of nerve monitoring and mapping has been described, in which the main trunk and all facial nerve branches are percutaneously defined by a neurophysiologist and continuously monitored during surgery. 9,10 In this scenario, motor nerve identification and functional status are determined by the neurophysiologist in direct communication with the operating surgeon, allowing the surgeon to completely focus on efficient lesion removal, while relying on the neurophysiologist's interpretation of nerve activity.…”