Sclerotherapy for cervical cystic lymphatic malformations in children. Our experience with computed tomography-guided 98% sterile ethanol insertion and a review of the literature.
OBJECTIVE
The treatment of cystic lymphatic malformations of the neck and mediastinum is controversial. Surgical management may be limited by the invasiveness of the procedure, the complex anatomy of this region, and the high recurrence rate. An alternative therapeutic method is sclerotherapy. We report our experience in the treatment of cystic lymphatic malformations of the neck by computed tomography (CT)-guided instillation of 98% sterile ethanol in children.


METHODS
Eight children with clinical suspicion of cervical cystic lymphatic malformation were assessed by ultrasonography (US) and magnetic resonance imaging (MRI) to define the location, size, and number of cystic cavities. The CT-guided instillation of 98% sterile ethanol was performed. Cystic fluid was analyzed by fine-needle aspiration cytology. Clinical and US or MRI follow-up was performed after 1 and 3 months and at 1 and 2 years.


RESULTS
The results were excellent with complete disappearance of the lesion in 7 (87.5%) of 8 patients. One patient (12.5%) with satisfactory results required a second alcohol injection with an excellent outcome. No allergic reactions or complications were observed.


CONCLUSIONS
The CT-guided 98% sterile ethanol sclerotherapy is a good alternative to surgical therapy. This procedure seems accurate, minimally invasive, safe, low cost, and reliable without untoward complications. Moreover, it does not exclude later surgical treatment.
Unit of Pediatric Surgery, Department of Medical and Surgical Pediatric Sciences, University of Messina, 98125 Messina, Italy. impellizzerip@unime.it
Pietro
P
Impellizzeri
Carmelo
C
Romeo
Francesca Astra
FA
Borruto
Francesca
F
Granata
Gianfranco
G
Scalfari
Francesco Saverio
FS
De Ponte
Marcello
M
Longo
D000293:Adolescent; D044963:Biopsy, Fine-Needle; D002648:Child; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D018191:Lymphangioma, Cystic / Q000000981:diagnostic imaging / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D015641:Radiography, Interventional; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
D012597:Sclerosing Solutions; D000431:Ethanol