Arteriovenous malformations of the head and neck: natural history and management.

摘要: This is a retrospective review of 81 patients with extracranial arteriovenous malformation the head and neck who presented to Vascular Anomalies Program in Boston over last 20 years. study focused on natural history effectiveness treatment. The male female ratio was 1:1.5. Arteriovenous malformations occur anatomic patterns. Sixty-nine percent occurred midface, 14 upper third face, 17 lower third. most common sites were cheek (31 percent), ear (16 nose (11 forehead (10 percent). A vascular anomaly apparent at birth 59 (82 men, 44 women). Ten noted onset childhood, 10 adolescence, 21 adulthood. Eight first puberty, six others experienced exacerbation during puberty. Fifteen women appearance or expansion pregnancy. Bony involvement 22 patients, commonly maxilla mandible. In seven bone primary site; 15 other involved secondarily. categorized according Schobinger clinical staging: 27 stage I (quiescence), 38 II (expansion), III (destruction). There single patient IV (decompensation). Stage lesions remained stable for long periods. Expansion (stage II) usually followed by pain, bleeding, ulceration III). Once present, these symptoms signs inevitably progressed until resected. Resection margins best determined intraoperatively bleeding pattern incised tissue Doppler. Subtotal excision proximal ligation frequently resulted rapid progression malformation. overall cure rate 60 percent, defined as radiographic absence Cure small 69 only 62 extensive combined embolization-resection. 75 I, 67 II, 48 malformations. Outcome not affected significantly age treatment, sex, stage, treatment method. Mean follow-up 4.6