Mwh. Erdmann et al., MULTIDISCIPLINARY APPROACH TO THE MANAGEMENT OF HEAD AND NECK ARTERIOVENOUS-MALFORMATIONS, Annals of the Royal College of Surgeons of England, 77(1), 1995, pp. 53-59
Arteriovenous malformations (AVM) of the head and neck are quite rare
in contrast to low-flow vascular anomalies, but often present with sig
nificant haemorrhage or cosmetic defects. Treatment of these high-flow
vascular anomalies is hazardous and has a predictably high incidence
of recurrence if not managed correctly. Intervention is indicated for
complications such as pain, haemorrhage, pressure symptoms, ischaemic
ulceration and even congestive cardiac failure. A multidisciplinary te
am approach is required in the assessment and treatment of these lesio
ns, and involves preoperative angiography with superselective embolisa
tion, followed by resection of the lesion, ideally within 72 h. Recent
advances in microsurgery and in therapeutic radiology have greatly im
proved the prognosis for patients with these malformations. We present
a series of four patients who have undergone preoperative embolisatio
n and subsequent surgical excision, with a mean follow-up of 28 months
. The complication rate has remained low and there has been no re-expa
nsion of the lesions to date.