Method for Safely Excising a Large Head and Neck Arteriovenous Malformation in the Hybrid Operating Room.

Kenneth A Pessino, Rafael A Ortiz, Nicholas Bastidas

The Journal of craniofacial surgery 2020 Sep

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Large head and neck arteriovenous malformations are notoriously difficult to manage given their location and propensity for extreme hemorrhage. We propose a unique approach utilizing a Hyperform balloon and percutaneous Surgiflo sclerotherapy to provide intraoperative hemostatic stability during the excision of a left-sided scalp arteriovenous malformation. In a hybrid operating room a microcatheter balloon was fed into the left external carotid artery for occlusion of the malformation's main blood supply, and subsequently followed with digital subtraction angiography guided sclerotherapy of selective vessels. A split thickness graft was used to reconstruct the site of excision. This method offered optimal hemostatic control with a blood loss less than 120 cc. Our approach may offer safety advantages over traditional modalities and allow resection of head and neck lesions previously thought to be inoperable.

Citation

Kenneth A Pessino, Rafael A Ortiz, Nicholas Bastidas. Method for Safely Excising a Large Head and Neck Arteriovenous Malformation in the Hybrid Operating Room. The Journal of craniofacial surgery. 2020 Sep;31(6):1773-1774