Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

Abstract

We performed a systematic review and meta-analysis of studies performing sclerotherapy for treatment of venous malformations (VMs) of the face, head and neck. It is our hope that data from this study could be used to better inform providers and patients regarding the benefits and risks of percutaneous sclerotherapy for treatment of face, head and neck VMs. We searched PubMed, MEDLINE, and EMBASE from 2000–2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of neck, face and head VMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the VM. Data were analyzed using random-effects meta-analysis. Thirty-seven studies reporting on 2,067 patients were included. The overall rate of complete cure following percutaneous sclerotherapy with any agent was 64.7% (95% confidence interval [CI], 57.4–72.0%). Sodium tetradecyl sulfate had the lowest complete cure rate at 55.5% (95% CI, 36.1–74.9%) while pingyangmycin had the highest cure rate at 82.9% (95% CI, 71.1–94.7%). Overall patient satisfaction rates were 91.0% (95% CI, 86.1–95.9%). Overall quality of life improvement was 78.9% (95% CI, 67.0–90.8%). Overall permanent morbidity/mortality was 0.8% (95% CI, 0.3–1.3%) with no cases of mortality. Our systematic review and meta-analysis of 37 studies and over 2,000 patients found that percutaneous sclerotherapy is a very safe and effective treatment modality for treatment of VMs of the head, neck and face.

Clinical evaluation and animal experimental study of different mass concentrations of pingyangmycin in the local injection treatment of lip venous malformation

“…In China, the most used method for venous malformations is the well-known antineoplastic agent pingyangmycin, applied as local injection therapy (19). Pingyangmycin has a chemical structure similar to bleomycin A5, and because of its safety, convenience, rapid and effective characteristics, intralesion injection of pingyangmycin has been widely used in the treatment of oral and maxillofacial-head and neck venous malformations (20). Studies have shown that the main mechanisms of pingyangmycin in the treatment of venous malformations sees pingyangmycin bind with vascular endothelial cell DNA causing DNA strand breakage and inhibition of the metabolism of vascular endothelial cells.…”

Interventional Treatment Options in Children with Extracranial Vascular Malformations

“…64 Regarding the head and neck lesions, as the most common localization, the possibility of swelling after sclerotherapy has to be considered, potentially requiring protective intubation for a few days. 65 However, this complication should be generally possible to avoid if the procedure is performed carefully and with consideration of distinct high-risk locations 66 67 (e.g., the tongue and the pharynx). The latter can pose even more clinical challenges: due to mucosal involvement, the tongue surface may be very susceptible to infection, bleeding, as well as irritation during feeding.…”

Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants

“…Three genes ( KRIT1 , CCM2 , and PDCD10 ) are known to cause familial CCM [ 39 ]. Venous malformation (VM) is relatively common in head and neck areas, which shows a good response to sclerotherapy [ 40 41 42 ]. Its prevalence or genetic association has not been well-recognized in Korea.…”