Giant complicated glosso-cervical arterio venous malformation managed with external carotid artery ligation and serial injection sclerotherapy: a case report and review of literature

Giant arterio venous malformation (AVM) of the tongue and floor of mouth are rare. They become life threatening when ignored by the patients. Treatment protocols are not well established. This report describes the treatment of a 35 years old female who presented to us with complains of swelling of tongue, floor of mouth and left sub mandibular region since 15 years causing dysphagia, and oral bleed since one day. Magnetic resonance Angiography revealed a giant AVM at the above site with dilated left external carotid artery (ECA) and left lingual artery. Patient underwent ECA ligation under general anaesthesia and serial injection sclerotherapy at the local site. After 3 months and 6 cycles of sclerotherapy, the patient had a satisfactory outcome. A detailed report with review of literature is presented.

Telangiectasia hemorrágica hereditaria: a propósito de un caso clínico / Hereditary hemorrhagic telangiectasia: on the subject of a clinical case

La epistaxis, es un síntoma frecuente en la consulta de otorrinolaringología. Dentro de las causas posibles encontramos la telangiectasia hemorrágica hereditaria (síndrome de Rendu Osler Weber), que corresponde a un desorden autosómico dominante caracterizado por sangrados nasales y gastrointestinales asociados a malformaciones arteriovenosas sistémicas. Su manifestación más frecuente es la epistaxis, presentándose más frecuentemente en personas mayores de 40 años, sin predilección por género. Se presenta el caso de un paciente de sexo masculino de 46 años quien consulta por epistaxis a repetición y severa. Durante la hospitalización se efectúa el tratamiento convencional de la epistaxis, diagnóstico retroactivo del síndrome de Rendu Osler Weber y manejo multidisciplinario de la patología. Se realiza revisión de la literatura y discusión del manejo del paciente que cursa con esta enfermedad.

Epistaxis is a common symptom in the otorhinolaryngology consultation. Among the possible causes are hereditary hemorrhagic telangiectasia (Rendu Osler Weber syndrome), which corresponds to an autosomal dominant disorder characterized by nasal and gastrointestinal bleeding associated with systemic arteriovenous malformations. Its most frequent manifestation is epistaxis, presenting more frequently in people over 40 years of age, without gender preference. We present the case of a male patient of 46 years old who consults for recurrence and severe epistaxis. During hospitalization, conventional treatment of epistaxis, retroactive diagnosis of Rendu Osler Weber syndrome and multidisciplinary management of pathology are performed. We review the literature and discuss the management of patients with this disease.

Congenital Lymphatic Malformation

Lymphatic malformation is one of common benign disease in head and neck lesion. It frequently arises from oral cavity, pharynx, skin, and mediastinum. Huge lymphatic malformation may result in dysfunction of vital structure. Lymphatic malformation, which has commonly ill-defined margin, would affect surrounding structures which include upper aero-digestive tract with unresectable margin. Lymphatic malformation is mainly treated with conservative methods. Recently, various treatment modalities have been introduced. So, we intended to describe this disease entity with the review of recent literature.

Posterior Knee Pain: An Unusual Cause.

The pain around the posterior knee called ‘popliteal fossa’ has been known to be caused by a variety of disease entities. Whatever the causes, the challenge remains in diagnosis. Proper history and clinical examination followed by uses of appropriate diagnostic tools are secrets to success. Venous malformation is a very rare cause of pain in popliteal area and its diagnosis is frequently delayed, missed or given incorrectly. Here, we report a case of a 24-year-old patient who presented with posterior knee pain for 2 years and was diagnosed as a case of intramuscular arterio-venous malformation by lower limb angiography. This patient was treated successfully by surgical resection. His follow-up was satisfactory with no evidence of recurrence.

Microsurgical approach of arteriovenous malformations in the central lobule / Abordagem microciúrgica para malformações arteriovenosas no lóbulo central

Arteriovenous malformations (AVM) are neurovascular disorders that occur mainly in young adults. Their clinical presentation is variable and depends on its location, size and occurrence of bleeding. They can represent incidental findings in neuro radiological exams. The treatment of these lesions when located in eloquent areas, namely around the central sulcus, is controversial, with different therapeutical approaches presented in the literature. We consider that surgical extirpation of many of these lesions is feasible in selected cases , when supported by profound anatomical knowledge and refined microsurgical technique, achieving cure with minimal aditional deficit. In the present article, we elaborate a surgical technique for the approach of AVMs located in the central sulcus, specially in finding the topographic lesion location and craniotomy.

Malformações arteriovenosas (MAV) são uma entidade patológica que ocorre mais frequentemente em adultos jovens. Sua manifestação clínica é variável e depende de sua localização, tamanho e ocorrência ou não de sangramento. Podem também ser diagnoticadas como achados incidentais em investigações neurorradiólogicas . O tratamento destas lesões, quando localizadas em áreas eloqüentes, em particular aquelas lesões localizadas próximas ao sulco central do cérebro, é controverso e diferentes abordagens terapêuticas são relatadas. Consideramos que a ressecção cirúrgica destas lesões é viável em casos selecionados, quando realizada sob profundo conhecimento anatômico e técnica microcirúrgica refinada, pois deste modo, as lesões podem ser curadas sem agregar morbidade ao paciente. No presente artigo, discutimos a técnica cirúrgica para MAVs localizadas nas adjacências do sulco central do cérebro, especialmente a localização topográfica da lesão e craniotomia.

A Case of Dural Arterio-venous Malformation Involving the Cavernous Sinus

Dural arterio-venous malformations are vascular communications in which blood flows through small meningeal branches of the carotid arteries to enter the venous circulation near the cavernous sinus. Dural arterio-venous malformations are distinct neuroophthalmological syndrome which consisisted of symptoms such as exphthalmos, increased intraocular pressure, ipsilateral headache, and dilatation of episcleral vessels, but they are difficult to diagnose clinically. Moreover it is difficult to differentiate them from the more common carotid-cavernous fistulas which represent similar symptoms of dural arteio-venous malformations. We report a case of dural arteriovenous malformation, involving the cavernous sinus and confimed with selective carotid arteriography, in a patient who presented with symptoms of unilateral tinnitus, conjunctival injection, and raised intraocular pressure, along with the review of literatures.

MlCROSURGICAL TREATMENT OF SPINAL ARTERIO-VENOUS MALFORMATION / 第二军医大学学报

Thirty cases of spinal AVM (male 23 and female 7) are described. The main clinic symptoms and signs were paralysis and dysfunction of sensation. The Queckcnstedt's test was an important examination.The protein content of CSF was 0.85-15.76 g/L(average 2.63 g/L), Twenty-three cases (76.6%) of spinal AVM were found in thoracic segment. The pathological types were arterio-venous malformation, capillary angioma and.spongy angioma. The best treatment of spinal AVM is microsurgical therapy, totally removing it. All of the patients were survival.They were followed up for 3 months-9 years. 14 cases (46.7%) returned to original work, 10(33.3%)could live independently, and only 6(20%) did not show any improvement.