Percutaneous sclerotherapy of microcystic lymphatic malformations: the use of an innovative gravity-dependent technique

• Published in: Journal of neurointerventional surgery Vol. 15; no. 3; pp. 272 - 275
• Main Authors: Berenstein, Alejandro, Bazil, Maximilian Jeremy, Sorscher, Michelle, Blei, Francine, De Leacy, Reade, Shigematsu, Tomoyoshi, Waner, Milton, Fifi, Johanna T
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.03.2023; BMJ Publishing Group LTD
• Subjects: Bleomycin - therapeutic use; Cell cycle; Cysts; Humans; Lymphatic Abnormalities - diagnostic imaging; Lymphatic Abnormalities - therapy; New devices and techniques; Patients; Retrospective Studies; Sclerosing Solutions - therapeutic use; Sclerotherapy; Sclerotherapy - methods; Technique; Treatment Outcome; Ultrasonic imaging; Vascular Malformation; Veins & arteries; Technique; Vascular Malformation
• ISSN: 1759-8478; 1759-8486
• DOI: 10.1136/neurintsurg-2021-018526

BackgroundIn the last few decades there has been development of innovative therapies for the treatment of craniofacial lymphatic malformations. Percutaneous sclerotherapy has demonstrated efficacy in the management of macrocystic lymphatic lesions, but it is less suitable for microcystic lesions given their size. The gravity-dependent technique is a novel augmentation of standard percutaneous sclerotherapy: the technique enables a sclerosing agent to permeate the small microchannels seen in microcystic lesions that would otherwise be difficult to treat.MethodsBetween 2005 and 2021, 124 patients with microcystic or mixed lymphatic malformations were treated using a novel gravity-dependent sclerotherapy technique. Bleomycin at a maximum dose of 15 IU per session was used as the main sclerosing agent. Fluoroscopy and ultrasound were used to ensure proper positioning of the catheter prior to injecting the sclerosing agent. The response to treatment was assessed clinically and with cross-sectional imaging.ResultsNearly all cases showed significant improvement after the gravity-dependent technique. There have been no permanent complications from sclerotherapy treatment. There was a mild transient adverse effect from bleomycin in one case of erythema and tenderness that lasted several weeks then ameliorated.ConclusionsThe gravity-dependent sclerotherapy technique is a suitable treatment option for microcystic lymphatic malformations.