Abstract
Craniofacial vascular malformation (CVM) is a major cosmetic concern and may present as catastrophic situations like bleeding apart from the functional impairment. The treatment of CVM has been very challenging. Till the recent past, surgery was the mainstay of treatment. However, because of the torrential intraoperative haemorrhage and frequent recurrences, embolization has evolved as a major adjunct in treating these lesions. This study evaluated the efficacy of various preoperative embolization techniques in the management of CVM. A total of 94 patients (54 males, 40 females) with an age range from three months to 68 years with a mean of 42.4 years having craniofacial AVM (forehead, face, neck and scalp lesions) were treated with the various embolization techniques: Arterial route with (a) hydrogel only (b) hydrogel and gelfoam (c) gel foam only (d) nbutyl cyanoacrylate (NBCA), Venous route and direct puncture injection of NBCA. The devascularisation achieved with the transarterial route was between 80–95% with particulate agents and 95–100% with NBCA. Direct puncture embolization also resulted in near total devascularisation of the lesion. This resulted in a significant decrease in blood loss at surgery. Cure was obtained in a few patients without the need for surgery. After embolization, almost all the patients had mild pain and subtle increase in the swelling with firmer consistency. The embolization of CVM is an essential adjunct to surgery in most cases and can be curative in a few patients. Hydrogel, PVA and gelfoam are good embolizing agents with NBCA being excellent when used with direct puncture.
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