Complex Arteriovenous Malformations in the Head and Neck and Skull Base Area: Results of Interdisciplinary Treatment with Embolization and Surgical Resection

Introduction: Among vascular anomalies arteriovenous malformations are especially demanding due to their high blood flow and life-long growth potential. They have to be clearly separated from hemangiomas and other vascular malformations. In our institution treatment of vascular malformations is coordinated by an interdisciplinary outpatient clinic with neuroradiologists, maxillofacial surgeons, plastic surgeons, pediatricians and dermatologists.

Patients and Methods: We report on 18 patients with complex arteriovenous malformations of the head and neck and skull base area. Treatment was planned after initial MRI and diagnostic angiography. In a second step embolization of the nidus and of the feeding vessels was performed immediately followed by surgical resection of the nidus. In a median follow-up time of 4 years, we saw good functional and aesthetic results in first-line treatment, in two cases a recurrence was seen.

Discussion and Conclusion: Our results were superior to those in previously and often incompletely treated patients. The outcome demonstrates that our staged and combined interdisciplinary approach is successful and can be recommended as a first line treatment. The patient must be informed that surgical resection will only be successful if the nidus can be resected completely. This may mean a compromise in function and/or aesthetics. Ligation of vessels e.g., of the external carotid artery or feeding vessels, isolated neuroradiological interventions and isolated non-radical surgery should be avoided. This can lead to incurable growth and lethal course.