RF Ablation as 1st line treatment for head & neck vascular malformation

Clinical Background

• 50 y.o man

• No significant past med hx

• Long-standing soft tissue lesions involving uvula, nasopharynx and left eyelid

• Occasional bleeding from uvula lesion especially when eating fried food – possibly due to abrasion.

• Left eye lesion soft & compressible. Enlarges on Valsalva.

Investigations

T2w fat suppressed

MRI

 T2w fat suppressed

US

Left eyelid - Predominantly hypoechoic, compressible lesion.

Left eyelid – Minimal intralesional vascularity.

•Imaging suggestive of slow flow vascular malformation, probably venous malformation.•Uvula is deep in oral cavity and loose piece of soft tissue.•Anticipate difficulty using ultrasound to target and also sclerotherapy needles may not anchor in lesion.•Offered RFA instead. Ability to target and ablate lesion under direct visualization.

Procedure

•Set-up–GA–Starmed 70/7mm and 70/4mm RF probes (alternatives Covidien Cool-Tip, Angio Dynamic, Boston Scientific RF)

Intra-procedural pictures of uvula lesion. Hi-res images can be provided for actual presentation.

Intra-procedural US of RF probe ablating eyelid lesion.

	D3 post procedure. Granulation tissue of uvula lesion. Hi-res images can be provided for actual presentation.
4 weeks post procedure. Significant reduction in size of uvula which has also healed. Remnant lesion involving soft palate not treaed. Hi-res images can be provided for actual presentation.

8 weeks post RFA of eyelid lesion. Reduction in size.

• Follow up at 4 weeks and 6 months. • Patient well. Satisfied with results.• No further oral bleeding.• Small remnant eyelid lesion but no longer enlarges with Valsalva or position. Conservative monitoring.

Discussion

•Sclerotherapy is 1st line for treatment of slow flow vascular malformations.•Use of RFA has been described in literature for cases which have not responded well to sclerotherapy.•However we demonstrate that RFA can be a reasonable 1st line alternative to sclerotherapy especially if sclerotherapy is challenging to perform. 

Advantages of RFA

•Can either use with US or direct visualization•Better ability to target different parts of the lesion in real time.•Microcystic lesions with non-communicating compartments may respond better to RFA.•Less swelling compared to sclerotherapy