Sunday, November 3, 2002 - 2:27 PM

The Utilization of Cardiopulmonary Bypass in the Resection of Very Large Craniofacial Vascular Malformations

Hanif Ukani, MD, H. Bruce Williams, MD, and M. Lucie Lessard, MD.

Background: Low flow cardiopulmonary bypass and circulatory arrest have been well described for the resection of intracranial vascular malformations. There are only isolated case reports of these procedures being used in the resection of craniofacial vascular malformations.

Purpose: To evaluate the use of cardiopulmonary bypass in the resection of very large craniofacial vascular malformations: To determine the indications for its use, to compare percutaneous femoral bypass to open bypass techniques, and to determine both short-term and long-term complications.

Methods: The study was conducted as a consecutive case series of all patients at the McGill University Health Center (MUHC), who had craniofacial vascular malformations resected with the aid of cardiopulmonary bypass. Charts were reviewed for (1) angiographic studies and embolizations conducted preoperatively, (2) the plastic surgeonís indication for the use of cardiopulmonary bypass (3) the operative intervention including bypass parameters, (4) short-term and long-term complications of the procedure.

Results: Cardiopulmonary bypass was used in the resection of 9 craniofacial vascular malformations from 1989-2001. Ages ranged from 2 to 33, with a mean of 18 yrs. Angiograms were conducted on all patients preoperatively. The major indication for the use of bypass was either a significant venous component of the vascular malformation, or incomplete superselective angiographic embolization of the malformation due to the risk of functional loss. All patients were operated in a low flow state after the induction of cardiopulmonary bypass and profound hypothermia. Procedures were conducted via either an open bypass (7 cases), or a closed femoral approach (2 cases). Of the open procedures 2 involved a period of circulatory arrest to excise the vascular lesion. There were 2 major cardiac intraoperative complications with difficulty reversing the cardiopulmonary bypass, and 1 major postoperative complication. The average length of postoperative hospital stay was 10 days. All patients went on to full recovery.

Conclusions: The use of cardiopulmonary bypass is a useful procedure in the resection of very large vascular malformations, in selected cases. There were no major long-term complications in this series. The use of complete circulatory arrest was not required in the majority of cases, and an adequate resection was usually possible with a low flow state alone.