Craniofacial cavernous venous malformations: percutaneous sclerotherapy with use of ethanolamine oleate

To assess the efficacy of percutaneous sclerotherapy with use of ethanolamine oleate for craniofacial cavernous venous malformations.

From 1991 to 2001, sclerotherapy (average of two procedures per patient) was performed in 29 patients (mean age, 22 y; 10 male) with craniofacial venous malformations. Direct puncture venography was performed with use of water-soluble contrast media to delineate the extent of the lesions. CO(2) gas was used as contrast medium in addition to water-soluble contrast media in five patients in whom lesions had large nondependent areas. Coil embolization with a transvenous approach was performed in two patients when the lesions had large draining veins. Then, a mixture of 5% ethanolamine oleate and iodized oil (ratio, 5:1-5:2) was injected manually into the lesions under fluoroscopic guidance to monitor the process. A total of 59 procedures were performed. Clinical follow-up was obtained in 25 of 29 patients. The duration of follow-up ranged from 10 days to 6 years (mean, 8.5 mo). The effectiveness of sclerotherapy was assessed on the basis of clinical, surgical, and radiologic findings.

The procedures were effective in 14 of 16 patients who underwent sclerotherapy only. The procedures were beneficial for all nine patients who underwent sclerotherapy and surgery. There was no skin injury or nerve damage. The trismus that appeared in two patients with lesions in the masticator space was treated well by conservative therapy.

Percutaneous sclerotherapy with use of ethanolamine oleate is a safe and effective treatment of craniofacial cavernous venous malformations. However, renal function was not specifically evaluated after treatment, and therefore occult renal dysfunction cannot be excluded.