Background and Purpose Venous malformations involving the posterior pharyngeal wall, hypopharynx and periglottic regions can result in substantial morbidity due to chronic and acute airway obstruction. Percutaneous sclerotherapy for management of these patients is challenging due to the proximity of these malformations to vital structures including the carotid and vertebral arteries. We retrospectively reviewed our institutional case series of patients who received sclerotherapy for airway venous malformations using a novel cone-beam CT needle guidance software.

Methods Following institutional review board approval, all patients with craniofacial venous malformations involving airway structures with the assistance of Philips Xper-Guide Cone Beam CT needle guidance were identified. We performed all interventions under general endotracheal anesthesia and the malformations were involving the airway. In general, patients were given an 8 mg dose of dexamethasone immediately prior to sclerotherapy. An XperCT was performed and XperGuide needle guidance was activated. Targets were chosen and using the needle guidance a 20 or 22 G spinal needle was advanced into the malformation. After confirmation of needle positioning with a venogram, Bleomycin (1 mg/1 mL) was injected slowly into the malformation using a negative roadmap technique. Following treatment, patients had airway monitoring in the ICU for a minimum of 4 hours following sclerotherapy and if no substantial swelling or airway compromise was noted, patients were extubated. Patients were generally sent home with a 5 day course of steroids to prevent swelling of the malformation following sclerotherapy. All patients received follow-up at 1 week, 6 weeks and 3 months. Studied outcomes included technical success rate, procedural complications and symptom improvement.

Results Over the past twelve months, a total of 12 consecutive patients received 20 sessions of bleomycin sclerotherapy for treatment of airway venous malformations with the assistance of Cone-Beam CT Needle Guidance (XperGuide, Philips). The most common indications for treatment were obstructive sleep apnea refractory to CPAP (6 patients) and difficulty swallowing solid foods (6 patients) For these 20 sessions, a total of 54 different venous malformations were targeted. In all cases, either 20G or 22G spinal needles were successfully advanced into the venous malformations and bleomycin sclerotherapy was administered. Thus, the technical success rate was 100%. There were no hemorrhagic or ischemic complications related to the sclerotherapy. In 19/20 sessions, patients were successfully extubated the day of the procedure. One patient required an additional day of intubation due to swelling of a glottic venous malformation following sclerotherapy. One patient had a corneal abrasion. 11/12 patients had improvement in the size and symptoms of the venous malformations.

Conclusions Cone Beam CT/XperGuide needle guidance is a useful tool for treatment of deep seated venous malformations, particularly those around the airway. In our case series we had high rates of technical success for delivery of sclerosant to these malformations and a low complication rate.

Disclosures W. Brinjikji: 1; C; NIH/NINDS, Johnson and Johnson/Cerenovus. 2; C; Johnson and Johnson/Cerenovus, Microvention. 4; C; Marblehead Medical LLC.