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Published on: March 5, 2016
Percutaneous sclerotherapy in neonatal and infant head and neck lymphatic malformations: a single center experience
Anne Marie Cahill1, Els Nijs, Deddeh Ballah
1Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
Percutaneous sclerotherapy using doxycycline shows excellent results for macrocystic head and neck lymphatic malformations in children. Microcystic and mixed lesions remain challenging to treat effectively.
Area of Science:
- Pediatric Surgery
- Interventional Radiology
- Vascular Anomalies
Background:
- Congenital head and neck lymphatic malformations (CHNLM) present a significant clinical challenge.
- Treatment options for CHNLM vary, with sclerotherapy emerging as a minimally invasive approach.
Purpose of the Study:
- To evaluate the clinical outcomes of percutaneous sclerotherapy for CHNLM in pediatric patients.
- To assess the efficacy and safety of doxycycline sclerotherapy in treating these lesions.
Main Methods:
- A retrospective review of 17 pediatric patients with CHNLM treated over 7 years.
- Sclerotherapy procedures utilized catheter-directed doxycycline (10 mg/mL), with additional agents like absolute ethanol or sodium tetradecyl sulfate used in some cases.
- Imaging response was categorized by volume reduction, and systemic doxycycline levels were monitored in recent cases.
Main Results:
- Significant imaging improvement (≥76% volume reduction) was observed in 11 of 17 patients, predominantly those with macrocystic lesions.
- Four patients achieved 51%-75% resolution, and two had 25%-50% resolution, often with mixed or microcystic lesions.
- Peri-procedural complications included hemolytic anemia and metabolic disturbances in neonates, with higher doxycycline doses (>250 mg) correlating with elevated serum levels. Delayed neural complications occurred in 7 procedures.
Conclusions:
- Catheter-directed doxycycline sclerotherapy offers excellent outcomes for large macrocystic head and neck lymphatic malformations.
- Microcystic and mixed lymphatic malformations present ongoing therapeutic challenges requiring further investigation.
Purpose:
To evaluate the clinical outcomes of percutaneous sclerotherapy for congenital head and neck lymphatic malformations in our institution.
Materials And Methods:
Over a 7-year period, 17 children (10 M, 7 F) mean age 5.8 months (5 days to 13 months) underwent 49 sclerotherapy procedures for congenital head and neck malformations. The imaging and clinical records were reviewed for each patient. Ten of 17 had macrocystic disease; 7 of 17 had microcystic disease. Imaging response was categorized by volume reductions of 0% to 25%, 25% to 50%, 50% to 75%, or 75% to 100%. A concentration of 10 mg/mL doxycycline was used routinely via catheter in 3 instillations with a dose range of 50 to 500 mg per session as per our standard protocol in 17 of 17 patients. In more recent patients, systemic doxycycline levels were obtained after instillations. Additional treatments included direct injection doxycycline (10/17), instillation of absolute ethanol (7/17) or sodium tetradecyl sulfate (4/17), or a combination of these methods.
Results:
Imaging improvement of ≥ 76% was noted in 11 of 17. Of these, 8 of 11 had macrocystic disease. Four of 17 had 51% to 75% resolution, of which 3/4 were mixed. Two of 17 children had 25% to 50% resolution with a mixed lesion. Seven of 49 peri-procedural complications: hemolytic anemia in 2 infants, hypoglycemic and metabolic acidosis in 3 neonates aged 7 to 10 days, transient hypotension during absolute alcohol instillation in 1 neonate, and self-limiting skin excoriation secondary to peri-catheter leakage of doxycycline in one neonate. Neonates prone to these systemic complications had doxycycline doses of greater than 250 mg and resulted in serum levels of >5 μg/mL but as high as 21 μg/mL. Delayed neural complications occurred in 7 of 49 procedures, Horner's syndromes in 4 of 49 procedures, transient left lip weakness in 1 of 49 procedures, right facial nerve palsy in 1 of 49 procedures, and transient left hemidiaphragm paralysis in 1/49 procedures.
Conclusion:
Our experience with catheter directed doxycycline sclerotherapy provides excellent results for large macrocystic head and neck lymphatic malformations. Microcystic and mixed lesions continue to provide a therapeutic challenge.
