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AJNR Am J Neuroradiol. 2010 May;31(5):955-60. doi: 10.3174/ajnr.A1940. Epub 2009 Dec 31.

Percutaneous sclerotherapy for facial venous malformations: subjective clinical and objective MR imaging follow-up results.

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Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.



Venous malformations are the most common of all vascular anomalies, 40% of which are found in the head and neck. We discuss results of percutaneous sclerotherapy using bleomycin for facial VMs by using subjective clinical assessment and objective changes on MR imaging.


Thirty-seven patients with facial VMs were treated by percutaneous sclerotherapy with bleomycin. Of these, 31 patients with 32 lesions had pre- and posttreatment MR imaging. Each lesion received between 1 and 9 sclerotherapy sessions (average, 3.5). MR findings and clinical results of treatment were retrospectively reviewed. Clinical results were based on the physician's physical examination and interview of the patient; these were classified as worse, unchanged, or better. Objective results on MR imaging were classified as worse, no change, minor improvement (<50% decrease in size), marked improvement (>or=50% decrease), or cure. Objective and subjective results were compared.


Twenty-one lesions showed objective improvement on MR imaging. Of these, 10 showed minor decrease in size and 11 showed marked decrease. Eleven lesions showed no change on MR imaging. No VMs were worse or completely cured. Subjectively, 29 patients and 30 clinicians thought that lesions improved. Four of 32 (12.5%) patients suffered minor transient complications.


Percutaneous sclerotherapy by using bleomycin is a safe technique to objectively decrease size and subjectively alleviate symptoms of facial VMs. Subjective clinical improvement is not always associated with visual size reduction on MR imaging. Minimal size reduction or partial fibrosis of the lesion may be enough to achieve subjective clinical improvement.

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