Fernández-Alvarez Verónica, Linares-Sánchez Miriam, Mäkitie Antti A, Suárez Carlos, de Bree Eelco, Karatzanis Alexander, Takes Robert P, Strojan Primoz, Rinaldo Alessandra, Ferlito Alfio
Department of Vascular and Endovascular Surgery, Torrecardenas University Hospital, Almeria, Spain.
Department of Vascular and Endovascular Surgery, Cabueñes University Hospital, Gijon, Spain.
Front Neurol. 2024 Aug 19;15:1447960. doi: 10.3389/fneur.2024.1447960. eCollection 2024.
Intravenous lipomas (IVLs) of the head and neck are uncommon benign tumors that develop within the venous walls, often detected incidentally during imaging for unrelated issues. While usually asymptomatic, these IVLs can cause congestive venous symptoms like swelling, paresthesia or pain in the head and neck and upper limbs, or even venous thromboembolism. The precise diagnosis of IVLs is predominantly achieved through computed tomography (CT) and magnetic resonance imaging (MRI), with CT being the most frequently used method. Symptomatic patients generally undergo open surgery with excision of the IVL followed by venous reconstruction, which has shown safe and effective outcomes. However, the management of asymptomatic IVLs remains controversial due to the limited number of reported cases. Despite this, there is a notable trend toward recommending surgical removal of IVLs to prevent complications and rule out malignancy, driven by the challenges of differentiating IVLs from malignant tumors using imaging alone. This review highlights the key differential imaging characteristics of IVLs and the main surgical techniques to remove the tumor and repair the vascular defect. Further research is necessary to establish a robust, evidence-based approach for treating asymptomatic IVLs, balancing the risks of surgery against the potential for future complications.
头颈部静脉内脂肪瘤（IVL）是一种罕见的良性肿瘤，生长于静脉壁内，常在因其他无关问题进行影像学检查时偶然发现。虽然这些IVL通常无症状，但可导致充血性静脉症状，如头颈部和上肢肿胀、感觉异常或疼痛，甚至静脉血栓栓塞。IVL的精确诊断主要通过计算机断层扫描（CT）和磁共振成像（MRI）实现，其中CT是最常用的方法。有症状的患者通常接受开放性手术，切除IVL后进行静脉重建，已显示出安全有效的结果。然而，由于报告病例数量有限，无症状IVL的管理仍存在争议。尽管如此，鉴于仅通过影像学将IVL与恶性肿瘤区分开来存在挑战，目前有一个明显的趋势是建议手术切除IVL以预防并发症并排除恶性肿瘤。本综述重点介绍了IVL的关键鉴别影像学特征以及切除肿瘤和修复血管缺损的主要手术技术。有必要进行进一步研究，以建立一种强有力的、基于证据的方法来治疗无症状IVL，平衡手术风险与未来并发症的可能性。
