title: Percutaneous sclerotherapy in neonatal and infant head and neck lymphatic malformations: a single center experience.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of percutaneous sclerotherapy for congenital head and neck lymphatic malformations in our institution.
  
  
  METHODS
  Over a 7-year period, 17 children (10 M, 7 F) mean age 5.8 months (5 days to 13 months) underwent 49 sclerotherapy procedures for congenital head and neck malformations. The imaging and clinical records were reviewed for each patient. Ten of 17 had macrocystic disease; 7 of 17 had microcystic disease. Imaging response was categorized by volume reductions of 0% to 25%, 25% to 50%, 50% to 75%, or 75% to 100%. A concentration of 10 mg/mL doxycycline was used routinely via catheter in 3 instillations with a dose range of 50 to 500 mg per session as per our standard protocol in 17 of 17 patients. In more recent patients, systemic doxycycline levels were obtained after instillations. Additional treatments included direct injection doxycycline (10/17), instillation of absolute ethanol (7/17) or sodium tetradecyl sulfate (4/17), or a combination of these methods.
  
  
  RESULTS
  Imaging improvement of ≥ 76% was noted in 11 of 17. Of these, 8 of 11 had macrocystic disease. Four of 17 had 51% to 75% resolution, of which 3/4 were mixed. Two of 17 children had 25% to 50% resolution with a mixed lesion. Seven of 49 peri-procedural complications: hemolytic anemia in 2 infants, hypoglycemic and metabolic acidosis in 3 neonates aged 7 to 10 days, transient hypotension during absolute alcohol instillation in 1 neonate, and self-limiting skin excoriation secondary to peri-catheter leakage of doxycycline in one neonate. Neonates prone to these systemic complications had doxycycline doses of greater than 250 mg and resulted in serum levels of >5 μg/mL but as high as 21 μg/mL. Delayed neural complications occurred in 7 of 49 procedures, Horner's syndromes in 4 of 49 procedures, transient left lip weakness in 1 of 49 procedures, right facial nerve palsy in 1 of 49 procedures, and transient left hemidiaphragm paralysis in 1/49 procedures.
  
  
  CONCLUSIONS
  Our experience with catheter directed doxycycline sclerotherapy provides excellent results for large macrocystic head and neck lymphatic malformations. Microcystic and mixed lesions continue to provide a therapeutic challenge.
authors.affiliation: Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Cahill
authors.forename: Els
authors.initials: E
authors.lastname: Nijs
authors.forename: Deddeh
authors.initials: D
authors.lastname: Ballah
authors.forename: Deborah
authors.initials: D
authors.lastname: Rabinowitz
authors.forename: Lynn
authors.initials: L
authors.lastname: Thompson
authors.forename: Natalie
authors.initials: N
authors.lastname: Rintoul
authors.forename: Holly
authors.initials: H
authors.lastname: Hedrick
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: David
authors.initials: D
authors.lastname: Low
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy; D000743:Anemia, Hemolytic / Q000139:chemically induced; D004318:Doxycycline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006732:Horner Syndrome / Q000139:chemically induced; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007223:Infant; D007231:Infant, Newborn; D007267:Injections; D007322:Instillation, Drug; D018191:Lymphangioma, Cystic / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D044148:Lymphatic Abnormalities / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D012597:Sclerosing Solutions; D000431:Ethanol; D004318:Doxycycline; D012981:Sodium Tetradecyl Sulfate