Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.
Otolaryngol Head Neck Surg. 2013 Apr;148(4):678-84. doi: 10.1177/0194599813475586. Epub 2013 Jan 28.
Describe single-stage removal of head and neck venous malformations using percutaneous embolization with n-butyl cyanoacrylate (n-BCA) glue prior to surgical resection.
Case series with chart review.
Tertiary-care pediatric hospital.
A total of 169 venous malformations were identified between 2000 and 2012, and 102 (60.1%) were in the head and neck. Thirty-five of 102 (34.3%) were observed, 56 of 102 (54.9%) had invasive therapy, and 11 of 102 (10.8%) underwent n-BCA embolization and surgery ("GES procedure"). The median age of the glue embolization and surgery cohort was 14 years (range, 6-19), and 7 of 11 (63.6%) were female. Treated venous malformations involved the oral cavity/tongue (4/11; 36.4%) and parotid/face (7/11; 63.6%). During facial lesion excision, intraoperative facial nerve monitoring was used. All surgical sites (11/11) were closed primarily. No patient in this cohort had any posttreatment nerve deficits, dysarthria, and dysphagia or lesion persistence.
Localized venous malformations can be treated with preoperative percutaneous embolization with n-BCA glue followed by surgical excision. This technique, with selective motor nerve monitoring, appears safe and allows for complete venous malformation removal with limited nerve dissection, to allow maximal tissue and functional preservation.
描述经皮穿刺使用 n-丁基氰基丙烯酸酯（n-BCA）胶栓塞后行一期切除头颈部静脉畸形的方法。
病例系列回顾。
三级儿童医院。
2000 年至 2012 年共发现 169 例静脉畸形，其中 102 例（60.1%）位于头颈部。102 例中有 35 例（34.3%）为观察病例，56 例（54.9%）采用侵袭性治疗，11 例（10.8%）接受 n-BCA 栓塞和手术（“GES 手术”）。胶栓塞和手术组的中位年龄为 14 岁（范围 6-19 岁），7 例（63.6%）为女性。治疗的静脉畸形涉及口腔/舌（4/11；36.4%）和腮腺/面（7/11；63.6%）。在面部病变切除术中，使用术中面神经监测。所有手术部位（11/11）均行一期直接缝合。该组患者无术后神经损伤、构音障碍、吞咽困难或病变残留。
术前经皮穿刺 n-BCA 胶栓塞可治疗局限性静脉畸形，然后行手术切除。这种技术，选择性运动神经监测，看起来是安全的，可以在有限的神经解剖下完全切除静脉畸形，从而最大限度地保留组织和功能。
