Isaac Kathryn V, Teshima Tara Lynn, Aviv Richard I, Fazl Mahmood, da Costa Leodante, Mainprize Todd, Antonyshyn Oleh
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto.
Division of Plastic and Reconstructive Surgery, Markham Stouffville Hospital, Markham.
J Craniofac Surg. 2018 May;29(3):622-627. doi: 10.1097/SCS.0000000000004014.
Intraosseous vascular anomalies (IOVA) are rare in the craniofacial skeleton and present a diagnostic and therapeutic challenge. This study aims to describe the clinical management based on a large case series.
A retrospective chart review was performed and 9 IOVA were identified over a 15-year period. Data on demographics, diagnostic features, clinical management, and outcomes were reviewed.
Five frontal bone IOVA and 4 orbital IOVA were identified. The postoperative follow-up ranged from 4 months to 4 years. All 9 lesions were diagnosed with computed tomography (CT) imaging. Magnetic resonance imaging (MRI) was used to delineate soft tissue involvement in 2 patients presenting with oculo-orbital dystopia and ophthalmoplegia. En bloc excision was performed in all patients. Preoperative interventional embolization was critical in the successful resection of an orbital IOVA following 2 previously failed attempts that were aborted secondary to hemorrhage. Intraoperative 3-dimensional stereotactic navigation was used for the accurate en bloc excision of a frontal IOVA to prevent injury to the frontal sinus. Reconstruction of esthetic and functional deformities was successfully accomplished.
The diagnosis of IOVA relies primarily on clinical assessment and CT imaging. Further interpretation of the involvement of periorbital, facial, and intracranial soft tissue is best defined by MRI. Multidisciplinary care with interventional radiology and neurosurgery must be considered for ensuring the safe and adequate en bloc excision of craniofacial IOVA.
骨内血管异常（IOVA）在颅面骨骼中较为罕见，对诊断和治疗构成挑战。本研究旨在基于一个大型病例系列描述其临床管理。
进行了一项回顾性病历审查，在15年期间确定了9例IOVA。对人口统计学、诊断特征、临床管理和结果的数据进行了审查。
确定了5例额骨IOVA和4例眼眶IOVA。术后随访时间为4个月至4年。所有9个病变均通过计算机断层扫描（CT）成像诊断。磁共振成像（MRI）用于描绘2例出现眼球眼眶发育异常和眼肌麻痹的患者的软组织受累情况。所有患者均进行了整块切除。在之前两次因出血而中止的尝试失败后，术前介入栓塞对成功切除眼眶IOVA至关重要。术中使用三维立体定向导航精确整块切除额部IOVA，以防止损伤额窦。成功完成了美学和功能畸形的重建。
IOVA的诊断主要依赖于临床评估和CT成像。眼眶周围、面部和颅内软组织受累情况的进一步解读最好通过MRI来明确。必须考虑介入放射学和神经外科的多学科护理，以确保安全、充分地整块切除颅面IOVA。
