PT  - JOURNAL ARTICLE
AU  - M Travis Caton
AU  - Madhavi Duvvuri
AU  - Amanda Baker
AU  - Eric R Smith
AU  - Kazim H Narsinh
AU  - Matthew R Amans
AU  - Steven W Hetts
AU  - Randall T Higashida
AU  - Daniel L Cooke
AU  - Christopher F Dowd
TI  - <strong>Percutaneous sclerotherapy for head and neck lymphatic malformations in neonates and infants</strong> ≤<strong>12 months of age</strong>
AID  - 10.1136/jnis-2022-019516
DP  - 2022 Nov 22
TA  - Journal of NeuroInterventional Surgery
PG  - jnis-2022-019516
4099  - http://jnis.bmj.com/content/early/2022/11/22/jnis-2022-019516.short
4100  - http://jnis.bmj.com/content/early/2022/11/22/jnis-2022-019516.full
AB  - 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.