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The Management of Hemangiomas and Vascular Malformations of Head and Neck
KS Goleria
1:
HEMANGIOMAS AND VASCULAR MALFORMATIONS—A MANAGEMENT ORIENTED CLASSIFICATION
THE FIRST BIOLOGICAL CLASSIFICATION (1863)
MULLIKEN AND GLOWACKI'S BIOLOGICAL CLASSIFICATION (1982)
THE HAMBURG CLASSIFICATION (1988–1989)
THE IAN JACKSON CLASSIFICATION (1993)
THE ORBITAL SOCIETY'S CLASSIFICATION
THE BIOLOGICAL BEHAVIOR OF THE VARIOUS CHANNELS
The Hemangiomas
The Vascular Malformations
The Small Channel Group
The Large Channel Group
WHY A MANAGEMENT ORIENTED CLASSIFICATION?
SUMMARY
2:
IMAGING FOR THE MANAGEMENT OF HEMANGIOMAS AND VASCULAR MALFORMATIONS
ROLE OF RADIOLOGICAL INVESTIGATIONS
INITIAL WORK-UP
Sonography and Doppler
CT Scan
MRI
Angiography
HEMANGIOMAS (CAPILLARY HEMANGIOMAS OF INFANCY)
A Small Channel High Flow System
Angiography
VASCULAR MALFORMATIONS
Capillary, Lymphatic, Venules Combinations (CLVCs)
(Small Channel Low Flow Vascular Malformations)
Capillary Malformations
Lymphatic Malformations
Venous Malformations
(Large Channel Low Flow Vascular Malformations)
Ultrasound and Doppler
CT Scan
MRI
AVMs
Arterial and Arteriovenous Malformations
(Large Channel High Flow Vascular Malformations)
Ultrasound and Doppler
CT Scan
MRI
Angiography
Combined High and Low Flow Lesions
Imaging Controlled Ablation
CONCLUSION
3:
CAPILLARY HEMANGIOMA OF INFANCY (CHI): A SMALL CHANNEL FAST FLOW LESION
NOMENCLATURE
INCIDENCE AND DISTRIBUTION
THE BIOLOGICAL PROGRESSION
Manifestation and Proliferation
Involution
Postinvolution
A CASE STUDY
DIAGNOSIS
Special Investigations
VARIANTS
Congenital Hemangiomas
Hemangiomatosis
MANAGEMENT
General and Prophylactic
Spontaneous Healing
Urgent/early Intervention
Lesions in and around the Orbit
Ulceration
Bleeding
Intralesional Steroids
Intralesional Sclerosant
Surgical Intervention
Use of Lasers
Surface Applications
SUMMARY
4:
SMALL CHANNEL LOW FLOW VASCULAR MALFORMATIONS: CAPILLARY, LYMPHATIC, VENULE COMBINATIONS (CLVCS)
THE MIX-UP OF CHANNELS
BIOLOGICAL BEHAVIOR
CAPILLARY MALFORMATIONS (CMs)
The Specifics of Biological Behavior and Management
The Sturge-Weber Syndrome
Syndromes Involving Capillary Malformations on the Face
Management of Capillary Malformations
Cosmetics
Lasers
Surgery
LYMPHATIC MALFORMATIONS (LMs)
Subclassification, Nomenclature and Biological Behavior
The Macrocystic and the Microcystic Lymphatic Malformations
Macrocystic LMs
Microcystic LMs
Both the Macrocystic and the Microcystic Malformations can coexist
Microcystic Lymphatic Malformations
The Management
Influencing Factors
CASE STUDY 1
Capillary-Lymphatic-Venous-Malformation (CLVM)
CASE STUDY 2
Bilateral Macrocystic and Central Microcystic Lymphatic Malformation—
LMs—Treatment Modalities—RF an Effective Addition
Deeply Located Lymphatic Malformations
CASE STUDY 3
Lymphatic Malformation with Iatrogenic Problems (Fig. 4.6)
Assessment
Preoperative Preparation
Coping with Soft Tissue Impediments
A Difficult Intubation
The Operation
The Reduction of Lymphangiomatous Mass
The Skeletal Correction
Postoperative Care
Follow-up Surgery Still Needed
SUMMARY
5:
HEMANGIOMAS AND VASCULAR MALFORMATIONS OF THE ORBIT
INTRODUCTION
CAPILLARY HEMANGIOMAS OF INFANCY
THE SUPERFICIAL CHI
THE DEEP CHI
COMBINED SUPERFICIAL AND DEEP CHI
COMPLEX CAPILLARY HEMANGIOMAS
IMAGING CAPILLARY HEMANGIOMAS
Ultrasonography
CT Scan
MRI Imaging
Surgical Intervention
The Surgical Approach
HISTOPATHOLOGY
The Management of Infantile Hemangiomas
Systemic Steroids
Triamcinalone Injection Administration
Complications of Triamcinalone Injections
Systemic Complications of Steroid Therapy
Interferon Alfa (INF)
Lasers
Management of Post Involutional Sequelae of the Hemangiomas
SYNDROMIC HEMANGIOMAS
PHACE Syndrome or Neurocutaneous Syndrome
Kasabach-Merritt Syndrome
MALIGNANT VASCULAR NEOPLASMS
Hemangiopericytoma
Treatment
Vascular Malformations
SMALL CHANNEL NO FLOW VASCULAR MALFORMATIONS
Lymphangiomas
Classification
Displacement of the Globe
Effects on the Skeleton
LYMPHANGIOMA IMAGING
Ultrasonography (USG)
CT Scan
MRI Imaging
Histology
Management
The Surgical Approach
The Anterior Superior Orbitotomy
Limitations and Complications
CAPILLARY MALFORMATIONS
Local Management at this Stage
VENOUS MALFORMATIONS OF THE ORBIT6
Orbital Varix—The Distensible Orbital Venous Malformation
An Intraconal Orbital Varix
Orbital Varix Investigations
USG
CT Scan
MR Imaging
Histopathology
Management of Distensible Orbital Venous Malformations
The Nondistensible Orbital Venous Malformation
ORBITAL HEMATOMA
Imaging
Clinical Presentation
CAVERNOUS VENOUS MALFORMATIONS (CAVERNOUS HEMANGIOMAS)
INVESTIGATIONS
USG
CT scan
MRI Imaging
MANAGEMENT
Surgical Ablation
Anterior Superior Orbitotomy
Anterior Inferior Transconjunctival Orbitotomy
Lateral Orbitotomy
Multiple Cavernous Hemangiomas
Removal of Cavernous Malformations—A Few Observations
Complications
AVMs—Arterio Venous Malformations
CONCLUSION
6:
LASERS IN HEMANGIOMAS AND VASCULAR MALFORMATIONS
INTRODUCTION
ADVANTAGE OF LASERS
ABOUT LASERS
LASER PHYSICS
Characteristics of Laser
Monochromaticity
Coherence
Directionality
Brilliancy
LASER TERMINOLOGY
Wavelength Relevant to the Management of Hemangiomas
Sequence of Events in Laser Tissue Interaction
Variables to be Controlled for Effective Treatment
Skin Type and Delivery of the Energy
The Logic of Laser Usage in Hemangiomas
Factors Affecting the Efficacy of Laser Treatments
Transvenous Ablation as for Varicose Veins
Carbon Dioxide Laser and Radiofrequency
CLINICAL APPLICATIONS OF LASERS IN VASCULAR MALFORMATIONS
Lasers in Capillary Hemangiomas of Infancy
Lasers for Precision Hemostasis
Lymphangioma Treated with RF
What to Expect When Treating Hemangiomas with Lasers?
Aftercare
Laser Safety
Recurrences
Complications
Treatment Advances
SUMMARY
7:
VENOUS MALFORMATIONS (VMs): A LARGE CHANNEL LOW FLOW LESION
MANIFESTATION
BIOLOGICAL BEHAVIOR—FEATURES AND GROWTH
DIAGNOSTIC ERRORS AND INADEQUATE EXPOSURES CAN BE DISASTEROUS
SOME OTHER FEATURES RELATED TO VMs
MANAGEMENT
Investigations
THERAPEUTIC MEASURES
Embolization
Preoperative Direct Embolization — NBCA Glue
Surgery
Differentiating the ‘Feeders’ and the ‘Drainers'
The Choice of Approach
Atraumatic Technique and Choice of Instruments
SUMMARY
8:
VASCULAR MALFORMATIONS OF THE BRAIN
PIAL ATERIOVENOUS MALFORMATIONS (AVM) AND ATERIOVENOUS FISTULA (AVF)
Clinical Presentation
Investigations
Natural History of Brain AVM
Treatment
No Treatment
Surgical Excision
Embolization
Radiosurgery (SRS)
DURAL ARTERIOVENOUS MALFORMATIONS (DAVMs)
DEVELOPMENTAL VENOUS ANOMALIES (DVAs)
CAVERNOMA
CAPILLARY TELANGIECTASIA
CEREBROFACIAL ARTERIOVENOUS METAMERIC SYNDROME (CAMS)
Bone Hemangiomas
9:
ARTERIAL AND ARTERIOVENOUS MALFORMATIONS (AVMs): CHARACTERIZED BY LARGE CHANNEL HIGH FLOW VASCULAR MALFORMATIONS
MANIFESTATION
BIOLOGICAL BEHAVIOR
MANAGEMENT
Investigations
Therapeutic Options
Embolization Alone—A Restricted Option
Embolization Followed by Surgery
AVM with Bone Destruction
The Importance of Nidus Removal
CASE STUDY
Importance of Early Eradication
Psychosocial Support
AVM of the Jaws
SUMMARY
10:
THE STEAL PHENOMENON AND ITS MANAGEMENT
STEAL AND NIDUS
A CASE STUDY OF AN ARTERIOVENOUS MALFORMATION
PAST SURGICAL HISTORY
MANAGEMENT
Evaluation
Ablation and Disseminated Intravascular Coagulation (DIC)
THE RECONSTRUCTION
SUMMARY
ACKNOWLEDGMENT
APPENDIX: EXISTING NOMENCLATURE OF HEMANGIOMAS AND VASCULAR MALFORMATIONS: A SOURCE OF CONFUSION
VASCULAR TUMORS OF INFANCY AND CHILDHOOD
VASCULAR MALFORMATIONS
MIXED VASCULAR MALFORMATIONS
OTHER MULTIPLE VASCULAR MALFORMATION SYNDROMES
ANGIOKERATOMAS
LYMPHATIC MALFORMATIONS
VENOUS MALFORMATIONS
ARTERIAL AND ARTERIOVENOUS MALFORMATIONS
INDEX
TOC
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