Image-fusion-based surgical navigation in sclerotherapy for low-flow vascular malformations in the risky regions of head and neck

doi:10.3969/j.issn.1674-8115.2021.05.023

Abstract

Abstract: Objective

·To evaluate the feasibility and safety of image-guided surgical navigation, a real-time stereotactic guidance technique, in sclerotherapy of low-flow vascular malformations in the risky regions of head and neck.

Methods

·The patients with low-flow vascular malformations in the heads or necks who underwent surgical navigation-assisted sclerotherapy in the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively included. The preoperative CT images and magnetic resonance images were fused to design the puncture trajectory. During the operation, the navigation system was used to puncture according to the designed path, and the results were verified by digital subtraction angiography. The technical success rate of intralesional needle placement and postoperative complications were analyzed.

Results

·A total of 19 procedures for 30 lesions performed on 10 patients with low-flow vascular malformations (6 cases with intraorbital lesions, and 4 cases with pharyngeal lesions) were included. The average age of initial procedure was 20.9 years. The technical success rate was 80.0% (24/30). No other complications were observed except a case of pneumonia caused by sclerosing agent-induced glottic ulcer after one procedure.

Conclusion

·Image-guided surgical navigation is a feasible and safe auxiliary technique for the lesions in the risky regions of head and neck.

Key words: surgical navigation, image fusion, vascular malformation, sclerotherapy, head and neck

CLC Number:

R543

Hao GU, Xi YANG, Zi-min ZHANG, Yun-bo JIN, Li HU, Hui CHEN, Xiao-xi LIN. Image-fusion-based surgical navigation in sclerotherapy for low-flow vascular malformations in the risky regions of head and neck[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(5): 695-700.

Figures/Tables 5

TrendMD

References 17

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Patient No.	Sex	Age/year	Site	Diagnosis	Previous treatment	Local symptom
1	Female	47	Left orbit	VM	Percutaneous sclerotherapy	Argamblyopia caused by blepharoptosis and swelling
2	Female	3	Left orbit	LM	Percutaneous sclerotherapy
3	Female	19	Left orbit	VM	Percutaneous sclerotherapy and laser
4	Male	6	Right orbit	LM	Percutaneous sclerotherapy
5	Female	8	Left orbit	LM	Percutaneous sclerotherapy
6	Male	16	Bilateral orbit	VM	Percutaneous sclerotherapy	Swelling
7	Male	27	Left face and neck	VM	Percutaneous sclerotherapy and laser	Dyspnoea (before tracheotomy)
8	Male	29	Right face and neck	VM	Percutaneous sclerotherapy, laser, and orthodontic orthognathic treatment
9	Male	33	Bilateral face and neck	VM	Laryngoscope-guided sclerotherapy, resection of phlebolith, and percutaneous sclerotherapy
10	Male	21	Bilateral face and neck	VM	Percutaneous sclerotherapy

Patient No.	Sex	Age/year	Site	Diagnosis	Previous treatment	Local symptom
1	Female	47	Left orbit	VM	Percutaneous sclerotherapy	Argamblyopia caused by blepharoptosis and swelling
2	Female	3	Left orbit	LM	Percutaneous sclerotherapy
3	Female	19	Left orbit	VM	Percutaneous sclerotherapy and laser
4	Male	6	Right orbit	LM	Percutaneous sclerotherapy
5	Female	8	Left orbit	LM	Percutaneous sclerotherapy
6	Male	16	Bilateral orbit	VM	Percutaneous sclerotherapy	Swelling
7	Male	27	Left face and neck	VM	Percutaneous sclerotherapy and laser	Dyspnoea (before tracheotomy)
8	Male	29	Right face and neck	VM	Percutaneous sclerotherapy, laser, and orthodontic orthognathic treatment
9	Male	33	Bilateral face and neck	VM	Laryngoscope-guided sclerotherapy, resection of phlebolith, and percutaneous sclerotherapy
10	Male	21	Bilateral face and neck	VM	Percutaneous sclerotherapy

Patient No.	Region	Approach	Result of puncture	Sclerosant	Complication	Follow-up/month
1	Left retrobulbar	Percutaneously	Success	B	None	16
2	Left retrobulbar	Percutaneously	Success	B	None	9
3	Left nasal intraorbital	Percutaneously	Success	BPF	None	3
	Left inferior intraorbital	Percutaneously	Success	BPF	None
4	Right superior nasal intraorbital	Percutaneously	Success	B	None	4
	Right inferior temporal intraorbital	Percutaneously	Success	B	None
5	Left superior nasal intraorbital	Percutaneously	Failure	No delivery	None	6
6	Right nasal intraorbital	Percutaneously	Success	BPF	None	4
	Left retrobulbar	Percutaneously	Success	BPF	None
7
1st procedure	Left nasopharynx	Transorally	Success	No delivery^①	None	2.5
	Lingual radix	Transorally	Success	BPF	None
2nd procedure	Left lingual radix	Transorally	Success	BPF	None	7.5
	Left nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left nasopharynx	Transorally	Failure	No delivery	None	3
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Success	BPF	None
4th procedure	Left nasopharynx	Transorally	Success	BPF	None	5
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Failure	No delivery	None
8
1st procedure	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	BPF	None	3.5
2nd procedure	Right lingual radix	Transorally	Success	BPF	None	8.5
	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	A & BPF	None
3rd procedure	Right lingual radix	Percutaneously through mouth floor	Success	BPF	None	8
9
1st procedure	Left supraglottic	Transorally	Success	BPF	None	4
	Right nasopharynx	Transorally	Failure	No delivery	None
	Glottis	Percutaneously	Success	A	Pneumonia caused by glottic ulcer
2nd procedure	Left laryngopharynx	Percutaneously through mouth floor	Success	BPF	None	1.5
	Right nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left supraglottic	Percutaneously through mouth floor	Success	BPF	None	11
10
1st procedure	Right nasopharynx	Transorally	Success	BPF	None	6
2nd procedure	Right oropharynx	Transorally	Success	A & BPF	None	5
3rd procedure	Pre-epiglottic space	Percutaneously through mouth floor	Success	BPF	None	3

Patient No.	Region	Approach	Result of puncture	Sclerosant	Complication	Follow-up/month
1	Left retrobulbar	Percutaneously	Success	B	None	16
2	Left retrobulbar	Percutaneously	Success	B	None	9
3	Left nasal intraorbital	Percutaneously	Success	BPF	None	3
	Left inferior intraorbital	Percutaneously	Success	BPF	None
4	Right superior nasal intraorbital	Percutaneously	Success	B	None	4
	Right inferior temporal intraorbital	Percutaneously	Success	B	None
5	Left superior nasal intraorbital	Percutaneously	Failure	No delivery	None	6
6	Right nasal intraorbital	Percutaneously	Success	BPF	None	4
	Left retrobulbar	Percutaneously	Success	BPF	None
7
1st procedure	Left nasopharynx	Transorally	Success	No delivery^①	None	2.5
	Lingual radix	Transorally	Success	BPF	None
2nd procedure	Left lingual radix	Transorally	Success	BPF	None	7.5
	Left nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left nasopharynx	Transorally	Failure	No delivery	None	3
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Success	BPF	None
4th procedure	Left nasopharynx	Transorally	Success	BPF	None	5
	Posterior wall of left oropharynx	Percutaneously through mouth floor	Failure	No delivery	None
8
1st procedure	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	BPF	None	3.5
2nd procedure	Right lingual radix	Transorally	Success	BPF	None	8.5
	Posterior wall of right nasopharynx and oropharynx	Transorally	Success	A & BPF	None
3rd procedure	Right lingual radix	Percutaneously through mouth floor	Success	BPF	None	8
9
1st procedure	Left supraglottic	Transorally	Success	BPF	None	4
	Right nasopharynx	Transorally	Failure	No delivery	None
	Glottis	Percutaneously	Success	A	Pneumonia caused by glottic ulcer
2nd procedure	Left laryngopharynx	Percutaneously through mouth floor	Success	BPF	None	1.5
	Right nasopharynx	Transorally	Failure	No delivery	None
3rd procedure	Left supraglottic	Percutaneously through mouth floor	Success	BPF	None	11
10
1st procedure	Right nasopharynx	Transorally	Success	BPF	None	6
2nd procedure	Right oropharynx	Transorally	Success	A & BPF	None	5
3rd procedure	Pre-epiglottic space	Percutaneously through mouth floor	Success	BPF	None	3

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