Faculty Collaboration Database

Combined Nd:YAG laser and bleomycin sclerotherapy under the same anesthesia for cervicofacial venous malformations: A safe and effective treatment option. Int J Pediatr Otorhinolaryngol 2018 May;108:30-34

Date

04/02/2018

Pubmed ID

29605361

DOI

10.1016/j.ijporl.2018.02.005

Scopus ID

2-s2.0-85042331830 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

INTRODUCTION: Extensive cervicofacial venous malformations (VM) pose significant challenges to a patient's quality of life (altered breathing, dysphagia, dysarthria). Treatment options include: 1) Surgical debulking; 2) Sclerotherapy; 3) laser therapy; or 4) Combined modalities. Recent studies have demonstrated the importance of multimodality and multidisciplinary management of these patients. However, no studies have described combined single anesthetic laser and sclerotherapy treatment. We sought to demonstrate the safety and efficacy of combined Nd:YAG laser and sclerotherapy under the same anesthetic administration.

METHODS: Retrospective review of 8 patients (Age 6 mo -74 yrs, x͂ 31) with extensive cervicofacial VM with significant airway involvement. Patients were treated with combined suspension laryngoscopy with Nd:YAG laser of airway VM followed by image guided direct puncture sclerotherapy using bleomycin in the airway VM and sodium tetradecyl sulfate (STS) foam in the cervicofacial VM during the same anesthetic encounter.

RESULTS: All 8 patients had extensive cervicofacial VMs that were symptomatic with snoring or orthopnea. Four of the patients had previously been treated at outside institutions with residual disease or significant complications. All patients remained intubated post procedure (Avg. 1.07 days) and tolerated extubation without re-intubation or any major complications. The average length of hospital stay was 3.2 days, of which 1.9 days were spent in the ICU. Patients reported symptomatic improvement or had decreased VM disease on MRI follow up.

CONCLUSION: Combined Nd:YAG laser therapy and sclerotherapy allows treatment of both superficial and deep components of VMs in a safe and efficient manner. In addition, suspension laryngoscopy provides improved visualization and access for the interventional radiologist in difficult to reach areas for sclerotherapy.

Author List

Gregory S, Burrows PE, Ellinas H, Stadler M, Chun RH

Authors

Robert H. Chun MD Professor in the Otolaryngology department at Medical College of Wisconsin
Michael Stadler MD Associate Dean, Chief Medical Officer, Associate P in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Antibiotics, Antineoplastic
Bleomycin
Child
Child, Preschool
Combined Modality Therapy
Female
Head
Humans
Infant
Laryngoscopy
Laser Therapy
Lasers, Solid-State
Length of Stay
Male
Middle Aged
Neck
Retrospective Studies
Sclerosing Solutions
Sclerotherapy
Sodium Tetradecyl Sulfate
Treatment Outcome
Vascular Malformations
Young Adult