Multimodality Image-Guided Sclerotherapy of Low-Flow Orbital Vascular Malformations: Report of Single-Center Experience

Harmoush, S.; Chinnadurai, Ponraj; Salek, Kamel El; Metwalli, Zeyad; Herce, Honey; Bhatt, Amit; Steinkuller, Paul G.; Vece, Timothy J.; Siddiqui, Shakeel; Pimpalwar, Ashwin; Marx, Douglas P.; Mawad, Michel E.; Pimpalwar, Sheena

doi:10.1016/j.jvir.2016.02.036

Cited by 16 publications

(7 citation statements)

References 29 publications

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“…2). On similar lines, Barnacle et al 18 reported the outcomes of LMs of the macrocystic morphology, treated with sodium tetradecyl sulfate under imaging control. All patients achieved a reduction in maximal lesion diameter of ≥50%, with complete radiologic resolution in 52%.…”

Section: Discussionmentioning

confidence: 78%

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Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Dave¹,

Madhuri²,

Kaliki

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: The aim of the study was to investigate the clinical resolution versus radiologic regression of orbital lymphatic malformations (LMs) following treatment with intralesional bleomycin sulfate sclerotherapy. Methods: A retrospective interventional study of 24 eyes with orbital LMs treated with nonimage-guided bleomycin sclerotherapy. The clinical and radiologic outcomes were classified as excellent, good, fair, and poor. Regression was assessed clinically and by radiologic volumetrics. Results: Mean age at presentation was 17 ± 18 years (median 11, range 5 months to 70 years). Lesion morphology was microcystic in 11 (46%), macrocystic in 8 (34%), and mixed in 5 (21%) eyes. Mean units of bleomycin injected per session were 4 ± 2 IU (median 5 IU, range 1–6 IU). Mean number of treatment sessions required was 2 ± 1 (median 2, range 1–6). Cumulative units of bleomycin injected were 11 ± 9 (median 9, range 1–38 IU). The clinical response was excellent in 19 (79%), good in 4 (17%), and fair in 1 (4%). The mean preoperative and postoperative lesion volumes were 7 ± 4 cm3 and 0.8 ± 1.2 cm3, respectively (p < 0.0001, 95% CI, −7.89 to −4.51). Radiologic resolution of LM was excellent in 6 (25%), good in 8 (33%), fair in 7 (29%), and poor in 3 (13%) eyes. Spearman’s rank correlation coefficient for correlation between clinical and radiologic grading was 0.51 (p = 0.01, 95% CI, 0.13–0.75%). There was a sustained tumor resolution without recurrence over a mean follow-up duration was 2 years (median 18 months; range 12–60 months). Conclusions: Bleomycin sclerotherapy for orbital LMs gives an excellent to good clinical response in 93%. However, a parallel radiologic regression is seen only in 58%. The endpoint to assess response should be clinical. Treatment till complete radiologic resolution may not be necessary.

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Section: Discussionmentioning

confidence: 78%

“…Harmoush et al 18 performed 22 sclerotherapy sessions in 17 patients with LMs using bleomycin with a dose between 1.5 and 15 units per session (median, 13 units). They performed sclerotherapy with multimodal imaging using ultrasound guidance in 13 and additional cone-beam CT in 4 eyes.…”

Section: Discussionmentioning

confidence: 99%

Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Dave¹,

Madhuri²,

Kaliki

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…To this end, we present an acute management approach that synthesizes current paradigms in the literature regarding these malformations [ Figure 8]. [4,10,11] Diagnostic imaging is crucial in initial lesion evaluation, especially with MRI to determine the three-dimensional extent of growth, evidence of complications such as intralesional hemorrhage, and treatment approach. [6] Ophthalmology and IR consultation for clinical stability, esthetic disturbances, and proximity to vital structures play a large role in therapeutic intervention, as seen in the first branch point of an acute management approach.…”

Section: Discussionmentioning

confidence: 99%

Acute approach to orbital lymphatic malformations

Bennett

Bhatt

Chau

et al. 2020

AJIR

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Pediatric lymphatic malformations (LMs) represent a rare, benign subtype of vascular malformations that can commonly occur in the head or neck region, specifically in or around the orbit. Orbital LMs typically require a multidisciplinary team of specialists and diagnostic imaging. Historically, treatment options for these periorbital LMs include imaging-guided drainage with sclerotherapy in addition to surgery, at times in conjunction with medical management. There exists debate in terms of an approach for management timing of these lesions across various treatment centers, and interventional radiologists should be informed regarding treatment timing considerations in evaluating patients for potential intervention. The aim of this case series is to review the current standards regarding therapeutic interventions for LMs in the literature and discuss an organized approach to guide the optimal treatment timing for the management of these lesions. In this case series, two pediatric patients – one 2 years old and one 12 years old – presented with a unilateral periorbital LM and received treatment at an academic tertiary care children’s hospital. The first patient was diagnosed with macrocystic periorbital LM after presenting with eye pain and eyelid swelling. After initial ultrasound-guided drainage to relieve eye pressure, the patient rebled into the LM and underwent sclerotherapy intervention. The second case involved a periorbital LM with intralesional hemorrhage presenting as a violaceous eyelid mass diagnosed after bumping into a swing. The patient was treated medically with interval growth of the LM and underwent subsequent sclerotherapy. Both patients responded well to ultrasound-guided sclerotherapy. The management timing and decision to intervene were based on consults from multidisciplinary services, age, risk factors, and clinical stability on presentation. We present two cases of pediatric periorbital LM and review an organized institutional approach for treatment timing based on paradigms in the literature.

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“…There is no consensus on the selection of sclerosing agent in the clinical practice and large randomized clinical trials are insufficient. Most clinicians select the sclerosing agent according to their own familiarity with sclerosing agents and the focus size (8,31,32). To the best of our knowledge, this is the first study to report the use of NBCA glue combined with absolute ethanol in the treatment of Puig's classified advanced venous malformations.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of absolute ethanol combined with n‑butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation in children

Zhang

et al. 2018

Exp Ther Med

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The aim of the present retrospective study was to investigate the clinical safety and efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation. Sclerotherapy was performed in 121 children (52 males and 69 females; age range, 5 months to 16 years) with venous malformations under general anesthesia between April 2009 and October 2014 at the Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China. The patients with venous malformations were diagnosed and classified according to the diagnostic criteria of the International Society for the Study of Vascular Anomalies. According to the characteristics of intraoperative percutaneous angiography, 21 patient cases (9 males and 12 females; age range, 6 months to 14 years) were classified as advanced Puig's venous malformation. These 21 patients were treated with absolute ethanol combined with n-butyl cyanoacrylate. The patients were followed-up for 6–24 months (average, 15 months) after treatment. Following treatment with absolute ethanol combined with n-butyl cyanoacrylate, 15 cases were controlled and the total effective rate was 71% (15/21). However, 1 patient developed skin ulcerations, which was classed as a minor complication, 1 patient developed ectopic embolism caused by n-butyl cyanoacrylate reflux, and 1 patient developed transient pulmonary hypertension, the latter two complications were classified as major. Notably, the incidence rate of minor and major complications were 14.3%. To conclude, the present findings indicated that absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy was a safe and effective method with a low complication rate in the treatment of Puig's classified advanced venous malformation in patients.

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Multimodality Image-Guided Sclerotherapy of Low-Flow Orbital Vascular Malformations: Report of Single-Center Experience

Cited by 16 publications

References 29 publications

Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Acute approach to orbital lymphatic malformations

Clinical efficacy of absolute ethanol combined with n‑butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation in children

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