title: Interventional management of high-flow craniofacial vascular malformations: a database analysis and review of the literature.
abstract: BACKGROUND
  High-flow craniofacial vascular malformations are uncommon, locally aggressive lesions that pose a therapeutic challenge.
  
  
  OBJECTIVE
  To report our experience with the treatment of high-flow craniofacial vascular malformations.
  
  
  METHODS
  After institutional review board approval was obtained, the neurointerventional databases of two institutions were retrospectively reviewed for vascular malformations from October 2010 to June 2015. All patients who had been treated for a high-flow craniofacial vascular malformation were included in the analysis. Clinical presentation, location, type, agent and techniques used, procedural complications, and clinical and imaging follow-up were included in the analysis.
  
  
  RESULTS
  Eighteen patients (12 female and 6 male) harboring 21 high-flow vascular malformations met the inclusion criteria in our study. All patients were symptomatic. One patient had two separated arteriovenous malformations (AVMs) (one nasal and the other forehead/scalp), and one patient had three separated scalp lesions. One patient with a nasal AVM had capillary malformation-AVM syndrome. Overall, 13 AVM and 8 arteriovenous fistuli were treated in 31 targeted embolization procedures (ranging from 1 procedure to 4 procedures, mean 1.7 procedures). Onyx was the predominant agent used in 25 procedures. In 31 procedures, 1 procedural complication (skin ulceration) occurred. At the end of the last treatment session 14 of the 21 lesions were cured. Symptomatic control was achieved in all cases, with resolution or significant improvement of the symptoms (mean follow-up of 10 months).
  
  
  CONCLUSIONS
  High-flow craniofacial vascular malformations can be successfully managed with interventional techniques.
authors.affiliation: Miami Cardiac & Vascular Institute, Miami, Florida, USA.|Baptist Neuroscience Center, Miami, Florida, USA.|Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.affiliation: Miami Cardiac & Vascular Institute, Miami, Florida, USA.|Baptist Neuroscience Center, Miami, Florida, USA.|Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
authors.affiliation: Miami Cardiac & Vascular Institute, Miami, Florida, USA.|Baptist Neuroscience Center, Miami, Florida, USA.
authors.forename: James
authors.initials: J
authors.lastname: Benenati
authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.|Division of Plastic and Reconstructive Surgery, Nicklaus Children's Hospital, Miami, Florida, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Perlyn
authors.affiliation: Interventional Neuroradiology Unit, Department of Radiology, Fundacion Jimenez-Diaz, Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Martínez-Galdámez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000000981:diagnostic imaging / Q000628:therapy; D016208:Databases, Factual; D019468:Disease Management; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013223:Statistics as Topic; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arteriovenous Malformation; Embolic; Fistula; Intervention; Vascular Malformation