Multidisciplinary approach to the management of head and neck arteriovenous malformations

Arteriovenous malformations (AVM) of the head and neck are quite rare in contrast to low-flow vascular anomalies, but often present with significant haemorrhage or cosmetic defects. Treatment of these high-flow vascular anomalies is hazardous and has a predictably high incidence of recurrence if not managed correctly. Intervention is indicated for complications such as pain, haemorrhage, pressure symptoms, ischaemic ulceration and even congestive cardiac failure. A multidisciplinary team approach is required in the assessment and treatment of these lesions, and involves preoperative angiography with superselective embolisation, followed by resection of the lesion, ideally within 72 h. Recent advances in microsurgery and in therapeutic radiology have greatly improved the prognosis for patients with these malformations. We present a series of four patients who have undergone preoperative embolisation and subsequent surgical excision, with a mean follow-up of 28 months. The complication rate has remained low and there has been no re-expansion of the lesions to date.