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Case series
Percutaneous sclerotherapy for head and neck lymphatic malformations in neonates and infants ≤12 months of age
  1. M Travis Caton1,2,
  2. Madhavi Duvvuri2,
  3. Amanda Baker2,
  4. Eric R Smith2,
  5. Kazim H Narsinh2,
  6. Matthew R Amans2,
  7. Steven W Hetts2,
  8. Randall T Higashida2,
  9. Daniel L Cooke2,
  10. Christopher F Dowd2
  1. 1 Neurosurgery, Mount Sinai Health System, New York, New York, USA
  2. 2 Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr M Travis Caton, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA; travis.caton{at}


Background Percutaneous sclerotherapy is an effective treatment for lymphatic malformations (LM) of the head and neck in adults. The purpose of this study was to examine the indications and efficacy of sclerotherapy for head/neck LM in the neonate and infant population.

Methods We retrospectively reviewed patients treated with percutaneous sclerotherapy for LM of the head/neck at age ≤12 months at a single vascular anomalies clinic. The clinical, anatomic, and technical aspects of each treatment, complications, and post-treatment clinical and imaging outcomes were analyzed.

Results 22 patients underwent 36 treatments during the first year of life. Median age at first treatment was 6.2 months (range 2–320 days). Severe airway compromise was the most frequent indication for treatment (31.8%). Sclerosants included doxycycline (80.5%), sodium tetradecyl sulfate (55.5%), bleomycin (11.1%) and ethanol (2.8%). There were no immediate procedure-related complications; sclerosant-related laboratory complications included transient metabolic acidosis (8.3%) and hemolytic anemia (5.5%). Median follow-up was 3.7 years (IQR 0.6–4.8). 47.6% of patients showed >75% lesion size reduction and 19.0% showed minimal response (<25% improvement). At last follow-up, 71.4% of children were developmentally normal and asymptomatic, 23.8% had recurring symptoms, and 4.8% required permanent tracheostomy. Patients with ongoing symptoms or limited response to percutaneous sclerotherapy (33.3%) were treated with long-term sirolimus.

Conclusions Percutaneous sclerotherapy is a safe and effective treatment for symptomatic LM of the head and neck in neonates and infants. Treatment strategy and management of recurrent symptoms requires consensus from an experienced, multidisciplinary team.

  • Malformation
  • Pediatrics
  • Congenital
  • Neck
  • Vascular Malformation

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  • Twitter @traviscaton, @amandaebaker, @EricRSmithMD

  • Contributors MTC: writing - original draft, conceptualization, methodology, formal analysis, visualization. MD: investigation, data curation. AB: investigation, conceptualization, data curation. ERS: writing - review and editing, data curation. KHN: writing - review and editing. MRA: writing - review and editing. SWH: writing - review and editing. RTH: writing - review and editing, supervision. DLC: investigation, methodology, data curation, supervision. CFD: writing - review and editing, resources, project administration, writing - review and editing, investigation, methodology, data curation, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.