Neurointervention.  2020 Mar;15(1):4-17. 10.5469/neuroint.2019.00213.

Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

• De Maria L
• De Sanctis P
• Balakrishnan K
• Tollefson
• Brinjikji

• KMID: 2502077
• DOI: http://doi.org/10.5469/neuroint.2019.00213

Abstract

We performed a systematic review and meta-analysis of studies performing sclerotherapy for treatment of venous malformations (VMs) of the face, head and neck. It is our hope that data from this study could be used to better inform providers and patients regarding the benefits and risks of percutaneous sclerotherapy for treatment of face, head and neck VMs. We searched PubMed, MEDLINE, and EMBASE from 2000–2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of neck, face and head VMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the VM. Data were analyzed using random-effects meta-analysis. Thirty-seven studies reporting on 2,067 patients were included. The overall rate of complete cure following percutaneous sclerotherapy with any agent was 64.7% (95% confidence interval [CI], 57.4–72.0%). Sodium tetradecyl sulfate had the lowest complete cure rate at 55.5% (95% CI, 36.1–74.9%) while pingyangmycin had the highest cure rate at 82.9% (95% CI, 71.1–94.7%). Overall patient satisfaction rates were 91.0% (95% CI, 86.1–95.9%). Overall quality of life improvement was 78.9% (95% CI, 67.0–90.8%). Overall permanent morbidity/mortality was 0.8% (95% CI, 0.3–1.3%) with no cases of mortality. Our systematic review and meta-analysis of 37 studies and over 2,000 patients found that percutaneous sclerotherapy is a very safe and effective treatment modality for treatment of VMs of the head, neck and face.

Keyword

Venous malformations; Venous; Head and neck; Sclerotherapy

Figure

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  Fig. 1. PRISMA flow diagram. VMs, venous malformations; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

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  Fig. 2. Forest plot: complete cure rates. Subgroup 1, bleomycin; subgroup 2, ethanol; subgroup 3, sotradecol; subgroup 5, mixed/other; subgroup 6, ethanolamine; subgroup 7, pingyangmycin. CI, confidence interval.

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  Fig. 3. Forest plot: permanent morbidity and mortality rates. Subgroup 1, bleomycin; subgroup 2, ethanol; subgroup 3, sotradecol; subgroup 5, mixed/other; subgroup 6, ethanolamine; subgroup 7, pingyangmycin. CI, confidence intervall; EV, number of events; TRT, number of treated patients.

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  Fig. 4. Forest plot: pulmonary complication rates. Subgroup 1, bleomycin; subgroup 2, ethanol; subgroup 3, sotradecol; subgroup 5, mixed/other; subgroup 6, ethanolamine; subgroup 7, pingyangmycin. CI, confidence interval; EV, number of events; TRT, number of treated patients.

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  Fig. 5. Forest plot: skin necrosis and scarring rates. Subgroup 1, bleomycin; subgroup 2, ethanol; subgroup 3, sotradecol; subgroup 5, mixed/other; subgroup 6, ethanolamine; subgroup 7, pingyangmycin. CI, confidence interval; EV, number of events; TRT, number of treated patients.

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