phenylephrine-hydrochloride and Arteriovenous-Malformations

Patients with hereditary haemorrhagic telangiectasia can present with a multitude of symptoms caused by telangiectasia and arteriovenous malformations in the nose, brain, gastrointestinal tract, liver and spinal cord. Clinicians should be aware of the potential diagnosis of hereditary haemorrhagic telangiectasia and how to manage these patients both in the acute and chronic setting. Identifying these patients and optimising their management can help reverse the reduced life expectancy back to that of the normal population. The management of these patients is complex and often requires a multidisciplinary approach, with difficult discussions to be had around screening for arteriovenous malformations and genetic testing. The stepwise management ladder can be used in both the medical and surgical strategies; there are multiple pharmacological and surgical options available, all with their own side effects and risks. Patient education is key to help informed decision making. This article outlines the clinical characteristics of the disease and management options available.

Topics: Arteriovenous Malformations; Epistaxis; Genetic Testing; Humans; Nose; Telangiectasia, Hereditary Hemorrhagic

Maxillofacial arteriovenous malformation located in the sensitive parts of the nose and lips has been an arduous challenge for doctors to meet a balance between resection and aesthetics in one time. In this report, one patient with a giant arteriovenous malformation covering the forehead, the nose, the lip, and bilateral cheeks and resulting in the appearance of the face like a lion's face, can not meet satisfactory outcomes by other therapeutic methods. We successfully reduced the size of vascular lesion using low-power and short-duration microwave ablation under real-time ultrasound guidance. In the two-year follow-up, the patient's face almost recovered to normality. Microwave ablation is expected to be a new alternative therapy for the treatment of maxillofacial arteriovenous malformations. Laryngoscope, 133:2984-2987, 2023.

Topics: Arteriovenous Malformations; Embolization, Therapeutic; Forehead; Humans; Microwaves; Nose

Positioned along the ventral surface of the pons, proximal superior cerebellar artery (SCA) aneurysms account for only 1.7% of all intracranial aneurysms [1]. Unlike more commonly encountered basilar artery aneurysms, patients often experience good outcomes when treated via endovascular coiling or surgical clipping [1,2]. These lesions frequently have a lateral projection and paucity of perforator arteries [2]. With further development of endoscopic endonasal techniques, access to this region is possible via a direct frontal exposure to the ventral brainstem, basilar artery and branching vessels. To date, there are only a limited number of reports describing an endoscopic endonasal transclival (EETC) approach for surgical clipping [3-5]. In this operative video, we detail the surgical clipping of a cerebellar arteriovenous malformation feeding vessel and an associated aneurysm using the EETC approach in a 59-year-old woman who presented with sudden onset of a severe headache. The feeding vessel and aneurysm's midline location, just below the take-off of the SCA made it a good candidate for this surgery. Major steps included in this video include 1) transsphenoidal exposure of and subsequent drilling of the clivus, 2) dural opening into the pre-pontine cistern and dissection of the aneurysm, 3) clipping of the aneurysm, and 4) multi-layered closure of the skull base defect. Overall, the patient tolerated the procedure well and was found to have no residual filling of the aneurysm or the AVM feeding vessel at 2-year follow-up. EETC is a viable surgical option for the treatment of aneurysm located along the midline of the pre-pontine cistern.

Topics: Arteriovenous Malformations; Cerebellar Diseases; Cerebellum; Endoscopy; Female; Humans; Intracranial Aneurysm; Middle Aged; Nose

Venous malformation is a common tumor of the orbit, presenting with visual impairment and proptosis. These lesions can be excised via an external or transcranial approach, but recent advances in minimally invasive surgery have led to increased popularity of endoscopic approach.. The authors report a 62-year-old female presenting with diplopia and proptosis, found to have a 1.7-cm venous malformation of the orbital apex. An endoscopic trans-nasal approach was undertaken for surgical resection.. The tumor was successfully removed in a single specimen, without injury to the nearby orbital anatomy. The patient experienced resolution of her presenting symptoms 3 weeks after the procedure, with no adverse effects. A review of the literature demonstrates increasing reports of similar successful cases.. A minimally invasive, endoscopic resection of orbital venous malformation is possible and provides a reasonably safe and effective approach. Further large-scale studies are needed to fully explore its outcomes relative to traditional approaches.

Topics: Arteriovenous Malformations; Diplopia; Endoscopy; Exophthalmos; Female; Humans; Middle Aged; Nose; Orbital Neoplasms

After reading this article, the participant should be able to: 1. Understand the rationale and value of principles of facial reconstruction in the complex patient. 2. Understand the importance of diagnosis and planning. 3. Appreciate the value of surgical staging. 4. Modify tissues to the requirements of the defect. 5. Know how to treat ischemic cover and lining complications. 6. Learn methods of late revision.. It is easy to be overwhelmed by a complex defect. What to do? How? When? In what order? Success is determined by careful planning, guided by principles. The aesthetic and anatomical deficiencies must be identified. Then, what is absent, both visually and anatomically, and what is missing must be determined. What are the priorities? What is the best timing for each stage? What are the available options and what will be the likely result? Should I choose another option? How can the surgeon maintain vascularity, transfer tissue, and improve tissue quality and contour? What are potential backup salvage maneuvers? Sound surgical principles based on the contributions of Gillies and Millard provide strategic instructions that help the surgeon "make sense" of a complex problem. They provide coordinated rules that clarify the diagnosis, planning, timing, and stages of repair. These should be combined with a regional unit approach to facial repair that provides tactical rules to establish the skin quality, border outline, and three-dimensional shape of the normal face.

Topics: Adolescent; Arteriovenous Malformations; Clinical Competence; Curriculum; Esthetics; Face; Female; Humans; Internship and Residency; Nose; Patient Care Planning; Plastic Surgery Procedures; Postoperative Complications; Reoperation; Rhinoplasty

The purpose of the present study is to evaluate the vascular malformations of the head and neck. They are uncommon lesions, but some areas have a significant potential for fatality, due to their massive bleeding. The vascular anatomy of the nose carries a high recurrence rate, due to the unique characteristic of the nose, especially if deep vascular connection is present.. The present article describes 2 patients of nasal dorsum arteriovenous malformations, both using a combined procedure: preoperative selective embolization, en-bloc tumor resection, and reconstruction with a forehead flap. Two female patients with arterio-venous malformations of the nose were examined, subjected to excision procedure and forehead flap reconstruction. Current treatment requires surgical resection of the nose and in conjunction with adjunctive endovascular embolization; it reduces arterio-venous malformations recurrence.. The authors report an endovascular and surgical technique to treat nasal arterio-venous malformations, which permits a complete resection and a reconstruction with a forehead flap. There were no major complications such as recurrent ulceration, infection, postoperative bleeding, or flap failure. All the patients responded positively and satisfactory results were achieved in both female patients.. To reduce the recurrence of arterio-venous malformations, the multidisciplinary therapy is mandatory. Recent advances in microsurgery and interventional radiology have greatly improved prognosis for patients with arterio-venous malformations. Therefore, a preoperative selective embolization followed by surgical excision seems to be a good compromise for arterio-venous malformations therapy. The forehead flap, for its characteristics, represents the better choice for nasal reconstruction.

Topics: Arteriovenous Malformations; Female; Forehead; Humans; Nose; Plastic Surgery Procedures; Surgical Flaps

Topics: Arteriovenous Malformations; Female; Humans; Low-Level Light Therapy; Masks; Middle Aged; Nose; Recurrence; Risk Factors; Treatment Outcome

Management of complex and relentless large arteriovenous malformations with long term control and acceptable aesthetic results can be accomplished. This outcome requires selective intra-arterial embolization, judicious surgical resection, composite reconstruction with free tissue transfer, other ancillary procedures, or both, and careful serial follow-up examinations to rule out recurrent or persistent disease.

Topics: Adult; Arteriovenous Malformations; Cysts; Forehead; Humans; Inflammation; Male; Necrosis; Nose; Plastic Surgery Procedures; Radiography; Scalp; Treatment Outcome; Vascular Surgical Procedures

Topics: Adult; Arteriovenous Malformations; Embolization, Therapeutic; Humans; Male; Nose; Radiography

A total of 22 patients--19 children, 3 adults--with a variety of hemangiomas and vascular malformations of the nose were treated over a 5-year period. Various laser modalities were used. Some lesions could be photocoagulated by the argon or the yttrium-aluminum-garnet (YAG) laser. Larger lesions were resected with the YAG laser and sapphire tips. Preliminary arteriography with superselective embolization was necessary in 1 patient. Total removal was possible in 13 patients, and no complications or side effects were noted.

Topics: Adult; Arteriovenous Malformations; Child; Child, Preschool; Female; Hemangioma; Humans; Infant; Laser Coagulation; Male; Nose; Nose Neoplasms

Topics: Arteriovenous Malformations; Humans; Nose; Surgical Flaps

The plastic surgeon is not a miracle worker, as so many of his patients believe. Nevertheless, he can do much to minimize the functional and cosmetic effect of many congenital deformities. If a moral can be drawn from this article it must be that the plastic surgeon should be given an early opportunity to see and assess the patients described here, if only to ease the anxiety in the minds of their parents by appropriate reassurance and discussion.

Topics: Arteriovenous Malformations; Breast; Congenital Abnormalities; Dermoid Cyst; Ear; Female; Fingers; Humans; Hypospadias; Leg; Lymphangioma; Lymphedema; Male; Nevus; Nevus, Pigmented; Nose; Skin Neoplasms; Surgery, Plastic; Vagina; Wrist