Sclerotherapy for lymphatic malformations of head and neck: Systematic review and meta-analysis

Lucio De Maria, Paolo De Sanctis, Karthik Balakrishnan, Megha Tollefson, Waleed Brinjikji

Research output: Contribution to journalReview article

Abstract

Background: Percutaneous sclerotherapy is a commonly used modality for treatment of lymphatic malformations (LMs) of the head, face, and neck. The safety and efficacy of sclerotherapy with various agents for diverse pathologic types of LMs have not been fully established. We present the results of a systematic review and meta-analysis examining the safety and efficacy of percutaneous sclerotherapy for treatment of LMs of the head, face, and neck. Methods: We searched PubMed, MEDLINE, and Embase from 2000 to 2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of head, face, and neck LMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the LM. Data were analyzed using random-effects meta-analysis. Results: There were 25 studies reporting on 726 patients included. The overall rate of complete cure of any pathologic type of LM after percutaneous sclerotherapy with any agent was 50.5% (95% confidence interval, 36.6%-64.3%). Macrocystic lesions had a cure rate of 53.1% compared with cure rates of 35.1% for microcystic lesions and 31.1% for mixed lesions. Regarding agents, doxycycline had the highest cure rate (62.4%) compared with all other agents. Overall permanent morbidity or mortality was 1.2% (95% confidence interval, 0.4%-2.0%) with no deaths. I2 values were >50% for most outcomes, indicating substantial heterogeneity. Conclusions: Our systematic review and meta-analysis of 25 studies and >700 patients found that percutaneous sclerotherapy is a safe and effective modality for treatment of LMs of the head, neck, and face.

Original languageEnglish (US)
Pages (from-to)154-164
Number of pages11
JournalJournal of Vascular Surgery: Venous and Lymphatic Disorders
Volume8
Issue number1
DOIs
StatePublished - Jan 2020

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Sclerotherapy
Meta-Analysis
Neck
Head
Safety
Confidence Intervals
Doxycycline
PubMed
MEDLINE
Therapeutics
Morbidity
Mortality

Keywords

  • Head and neck
  • Lymphatic malformations
  • Meta-analysis
  • Sclerotherapy
  • Systematic review

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Sclerotherapy for lymphatic malformations of head and neck : Systematic review and meta-analysis. / De Maria, Lucio; De Sanctis, Paolo; Balakrishnan, Karthik; Tollefson, Megha; Brinjikji, Waleed.

In: Journal of Vascular Surgery: Venous and Lymphatic Disorders, Vol. 8, No. 1, 01.2020, p. 154-164.

Research output: Contribution to journalReview article

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abstract = "Background: Percutaneous sclerotherapy is a commonly used modality for treatment of lymphatic malformations (LMs) of the head, face, and neck. The safety and efficacy of sclerotherapy with various agents for diverse pathologic types of LMs have not been fully established. We present the results of a systematic review and meta-analysis examining the safety and efficacy of percutaneous sclerotherapy for treatment of LMs of the head, face, and neck. Methods: We searched PubMed, MEDLINE, and Embase from 2000 to 2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of head, face, and neck LMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the LM. Data were analyzed using random-effects meta-analysis. Results: There were 25 studies reporting on 726 patients included. The overall rate of complete cure of any pathologic type of LM after percutaneous sclerotherapy with any agent was 50.5{\%} (95{\%} confidence interval, 36.6{\%}-64.3{\%}). Macrocystic lesions had a cure rate of 53.1{\%} compared with cure rates of 35.1{\%} for microcystic lesions and 31.1{\%} for mixed lesions. Regarding agents, doxycycline had the highest cure rate (62.4{\%}) compared with all other agents. Overall permanent morbidity or mortality was 1.2{\%} (95{\%} confidence interval, 0.4{\%}-2.0{\%}) with no deaths. I2 values were >50{\%} for most outcomes, indicating substantial heterogeneity. Conclusions: Our systematic review and meta-analysis of 25 studies and >700 patients found that percutaneous sclerotherapy is a safe and effective modality for treatment of LMs of the head, neck, and face.",
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T2 - Systematic review and meta-analysis

AU - De Maria, Lucio

AU - De Sanctis, Paolo

AU - Balakrishnan, Karthik

AU - Tollefson, Megha

AU - Brinjikji, Waleed

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N2 - Background: Percutaneous sclerotherapy is a commonly used modality for treatment of lymphatic malformations (LMs) of the head, face, and neck. The safety and efficacy of sclerotherapy with various agents for diverse pathologic types of LMs have not been fully established. We present the results of a systematic review and meta-analysis examining the safety and efficacy of percutaneous sclerotherapy for treatment of LMs of the head, face, and neck. Methods: We searched PubMed, MEDLINE, and Embase from 2000 to 2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of head, face, and neck LMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the LM. Data were analyzed using random-effects meta-analysis. Results: There were 25 studies reporting on 726 patients included. The overall rate of complete cure of any pathologic type of LM after percutaneous sclerotherapy with any agent was 50.5% (95% confidence interval, 36.6%-64.3%). Macrocystic lesions had a cure rate of 53.1% compared with cure rates of 35.1% for microcystic lesions and 31.1% for mixed lesions. Regarding agents, doxycycline had the highest cure rate (62.4%) compared with all other agents. Overall permanent morbidity or mortality was 1.2% (95% confidence interval, 0.4%-2.0%) with no deaths. I2 values were >50% for most outcomes, indicating substantial heterogeneity. Conclusions: Our systematic review and meta-analysis of 25 studies and >700 patients found that percutaneous sclerotherapy is a safe and effective modality for treatment of LMs of the head, neck, and face.

AB - Background: Percutaneous sclerotherapy is a commonly used modality for treatment of lymphatic malformations (LMs) of the head, face, and neck. The safety and efficacy of sclerotherapy with various agents for diverse pathologic types of LMs have not been fully established. We present the results of a systematic review and meta-analysis examining the safety and efficacy of percutaneous sclerotherapy for treatment of LMs of the head, face, and neck. Methods: We searched PubMed, MEDLINE, and Embase from 2000 to 2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of head, face, and neck LMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the LM. Data were analyzed using random-effects meta-analysis. Results: There were 25 studies reporting on 726 patients included. The overall rate of complete cure of any pathologic type of LM after percutaneous sclerotherapy with any agent was 50.5% (95% confidence interval, 36.6%-64.3%). Macrocystic lesions had a cure rate of 53.1% compared with cure rates of 35.1% for microcystic lesions and 31.1% for mixed lesions. Regarding agents, doxycycline had the highest cure rate (62.4%) compared with all other agents. Overall permanent morbidity or mortality was 1.2% (95% confidence interval, 0.4%-2.0%) with no deaths. I2 values were >50% for most outcomes, indicating substantial heterogeneity. Conclusions: Our systematic review and meta-analysis of 25 studies and >700 patients found that percutaneous sclerotherapy is a safe and effective modality for treatment of LMs of the head, neck, and face.

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KW - Lymphatic malformations

KW - Meta-analysis

KW - Sclerotherapy

KW - Systematic review

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