An Algorithm for Managing Intraosseous Vascular Anomalies of the Craniofacial Skeleton
Kathryn V Isaac1, Tara Lynn Teshima2, Richard I Aviv3,4
1Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto.
Insights
Intraosseous vascular anomalies (IOVA) of the craniofacial skeleton are rare but challenging. This study highlights successful surgical management through multidisciplinary care and advanced imaging techniques.
Area of Science:
- Craniofacial surgery
- Vascular anomalies
- Diagnostic imaging
Background:
- Intraosseous vascular anomalies (IOVA) of the craniofacial skeleton are uncommon and pose significant diagnostic and therapeutic challenges.
- This study presents a comprehensive clinical management strategy based on a large case series.
Observation:
- Nine cases of craniofacial IOVA were identified over 15 years, including frontal bone and orbital lesions.
- Computed tomography (CT) was the primary diagnostic tool, with magnetic resonance imaging (MRI) used for soft tissue assessment.
- Patients presented with varying degrees of oculo-orbital dystopia and ophthalmoplegia.
Findings:
- All nine IOVA were treated with en bloc excision, often requiring preoperative embolization and intraoperative 3D stereotactic navigation.
- Successful resection of complex orbital IOVA was achieved after previous failed attempts due to hemorrhage.
- Reconstruction addressed both esthetic and functional deficits.
Implications:
- Accurate diagnosis of craniofacial IOVA relies on clinical evaluation, CT, and MRI for soft tissue delineation.
- Multidisciplinary collaboration involving interventional radiology and neurosurgery is crucial for safe and effective surgical excision.
- Optimal management ensures successful en bloc resection and functional/esthetic reconstruction.
Background:
Intraosseous vascular anomalies (IOVA) are rare in the craniofacial skeleton and present a diagnostic and therapeutic challenge. This study aims to describe the clinical management based on a large case series.
Methods:
A retrospective chart review was performed and 9 IOVA were identified over a 15-year period. Data on demographics, diagnostic features, clinical management, and outcomes were reviewed.
Results:
Five frontal bone IOVA and 4 orbital IOVA were identified. The postoperative follow-up ranged from 4 months to 4 years. All 9 lesions were diagnosed with computed tomography (CT) imaging. Magnetic resonance imaging (MRI) was used to delineate soft tissue involvement in 2 patients presenting with oculo-orbital dystopia and ophthalmoplegia. En bloc excision was performed in all patients. Preoperative interventional embolization was critical in the successful resection of an orbital IOVA following 2 previously failed attempts that were aborted secondary to hemorrhage. Intraoperative 3-dimensional stereotactic navigation was used for the accurate en bloc excision of a frontal IOVA to prevent injury to the frontal sinus. Reconstruction of esthetic and functional deformities was successfully accomplished.
Conclusion:
The diagnosis of IOVA relies primarily on clinical assessment and CT imaging. Further interpretation of the involvement of periorbital, facial, and intracranial soft tissue is best defined by MRI. Multidisciplinary care with interventional radiology and neurosurgery must be considered for ensuring the safe and adequate en bloc excision of craniofacial IOVA.
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