Combined Nd:YAG laser and bleomycin sclerotherapy under the same anesthesia for cervicofacial venous malformations: A safe and effective treatment option
Autor: | Michael E. Stadler, Patricia E. Burrows, Stacie Gregory, Robert H. Chun, Herodotos Ellinas |
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Rok vydání: | 2017 |
Předmět: |
Adult
Male Orthopnea Adolescent Vascular Malformations medicine.medical_treatment Lasers Solid-State 030218 nuclear medicine & medical imaging Sodium Tetradecyl Sulfate 030207 dermatology & venereal diseases 03 medical and health sciences Bleomycin Young Adult 0302 clinical medicine Sclerotherapy Medicine Humans Child Aged Retrospective Studies Antibiotics Antineoplastic Laryngoscopy business.industry Infant General Medicine Length of Stay Middle Aged medicine.disease Debulking Dysphagia Combined Modality Therapy Sclerosing Solutions Sodium tetradecyl sulfate Treatment Outcome Otorhinolaryngology Anesthesia Child Preschool Pediatrics Perinatology and Child Health Anesthetic Female Laser Therapy medicine.symptom business Airway Venous malformation Head Neck medicine.drug |
Zdroj: | International journal of pediatric otorhinolaryngology. 108 |
ISSN: | 1872-8464 |
Popis: | 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, x 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. |
Databáze: | OpenAIRE |
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