Eivazi Behfar, Werner Jochen A
Department of Otolaryngology, Head & Neck Surgery, Philipps University of Marburg, Angioma Center Marburg, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014 Dec 1;13:Doc02. doi: 10.3205/cto000105. eCollection 2014.
The field of extracranial vascular anomalies is considered as special focus of pediatric otolaryngology and it has shown a rapid development during the last years. The reason for this interest is finally also due to the global acceptance of the classification introduced by the ISSVA (International Society for the Study of Vascular Anomalies). Hemangiomas are the most frequently observed vascular tumors. Today the systemic propranolol therapy is mostly used for therapy of hemangiomas requiring treatment. Increasingly, the topical application of beta blocker is discussed while the benefit in the head and neck seems to be limited. Vascular malformations are classified according to the morphology of the affected part of the vascular system in arterial, venous, arterio-venous, lymphatic, capillary, and combined vascular malformations. Conventional surgery, sclerosing therapy, and laser treatment are invasive options for the treatment of lymphatic malformations. The options for the treatment of venous malformations could be significantly improved during the last years. In this context, the use of Nd:YAG laser, the conservative treatment of the localized disseminated intravascular coagulation with low-molecular weight heparin, the re-discovery of bleomycin as effective sclerosing agent, and the improvement of alcohol-based embolization agents must be mentioned. Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy. Arterio-venous malformations as representatives for high-flow lesions are the high-risk lesions. Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course. The combined treatment of embolization and surgical resection and if necessary consecutive defect reconstruction have turned out to be appropriate for arterio-venous malformations. Incurable findings are still a major challenge. Despite the introduction of antiangiogenetic drugs in oncology, the medicamentous therapeutic approach could not be established for arterio-venous malformations up to now.
颅外血管异常领域被视为小儿耳鼻咽喉科的一个特殊重点，并且在过去几年中呈现出快速发展的态势。这种兴趣的产生最终也是由于国际血管异常研究学会（ISSVA）引入的分类方法得到了全球的认可。血管瘤是最常见的血管肿瘤。如今，系统性普萘洛尔疗法大多用于需要治疗的血管瘤。越来越多地讨论β受体阻滞剂的局部应用，而其在头颈部的益处似乎有限。血管畸形根据受影响的血管系统部分的形态分为动脉性、静脉性、动静脉性、淋巴性、毛细血管性和混合性血管畸形。传统手术、硬化治疗和激光治疗是治疗淋巴畸形的侵入性选择。在过去几年中，静脉畸形的治疗选择有了显著改善。在这方面，必须提到钕：钇铝石榴石激光的使用、用低分子量肝素对局部弥散性血管内凝血的保守治疗、博来霉素作为有效硬化剂的重新发现以及酒精基栓塞剂的改进。如今，染料激光治疗是毛细血管畸形的首选疗法，并且它优于其他治疗选择，例如光动力疗法。动静脉畸形作为高流量病变的代表是高风险病变。它们经常被与头颈部恶性肿瘤相比较，特别是当由于病变弥漫或多灶而无法保证进行根治性治疗且疾病呈进行性发展时。栓塞和手术切除联合治疗以及必要时连续的缺损重建已被证明适用于动静脉畸形。无法治愈的情况仍然是一个重大挑战。尽管肿瘤学中引入了抗血管生成药物，但迄今为止动静脉畸形的药物治疗方法尚未确立。
