Ethanol Permanent Ablation of Head and Neck Low-Flow Venous Malformations

Methods: Forty-eight patients (29 females, 19 males; mean age: 38 years) presented with tongue low-flow malformations.Forty-seven patients had undergone 61 failed previous procedures (embo, laser, surgery, steroid injection, alpha-interpheron, radiation).All patients had baseline arteriograms and MRs.All patients underwent direct puncture ethanol endovascular therapy to complete ablation.Results: Of 48 patients with venous and lymphatic malformations, 42 patients had dramatic reduction, and nine patients' therapy is on-going with progressive reductions (mean follow-up, 39 months).One patient with AVM required additional surgery, and one patient with mixed veno-lymphatic malformation required surgical debulking of excess tongue tissues.Minor complications such as tongue blisters (9 instances) healed spontaneously; three tongue focal areas of necrosis healed spontaneously; three infections responded to antibiotic treatment; one focal tongue hemi-numbness resolved.One patient had a lateral portion of the tongue slough and the tongue healed and remodeled with no treatment required.Conclusions: Ethanol embolotherapy is a primary and consistent form of therapy to eradicate low-flow vascular malformations of the tongue permanently at long-term MR follow-up.Rarely is concurrent surgery required.Ethanol sclerotherapy is a curative treatment in which recurrences do not occur, and permanent ablations appear to be the rule.Complications are usually managed conservatively.