Hello,
Thanks for asking this question. I want to first say that I am an
internal medicine physician and not a pediatrician. If you
are looking for more information, please do so via the answer
clarification option and I will be happy to explain or expand any of
my research.
You asked the following question:
“What is bifrontal hygromas, its treatment and prognosis in infants?”
1) What are hygromas?
From emdedicine:
“Cystic hygromas are multiloculated cystic structures that are benign
in nature. They form as the result of budding lymphatics and, thus,
may occur anywhere in the body, although they are most frequently
encountered in the neck (75%) and axilla (20%).”
http://www.emedicine.com/ped/topic536.htm
The hygromas you mentioned are bifrontal – although it mostly occurs
in the neck and axilla, it is possible for them to present in the
head.
From Archives of the AFIP:
“Cystic lymphangioma (cystic hygroma) is the most common type of
lymphangioma. It contains serous or chylous fluid and extends into the
mediastinum in 3% 10% of cases. Clinically, these lesions are soft,
fluctuant masses that involve the head, neck (75% of cases), and
axilla (20%).”
http://www.rsna.org/REG/publications/rg/afip/privateM/1995/0015/0004/0893/4.htm
2) What is the treatment?
Treatment can be divided into both medical and surgical options.
Surgery is preferred. This will be outlined from emedicine:
“Medical Care
- The medical treatment of cystic hygroma includes injection of
sclerosing agents and/or steroids. Treat an infection with intravenous
antibiotics and perform definitive surgery once the infection has
resolved. However, some infected cystic hygromas may improve with use
of a sclerosing agent, such as OK-432, which contains penicillin and
streptococci.
- Medical therapy with sclerosing agents is an alternative and should
be discussed with the patient.
- Bleomycin is a poor choice because of its toxicity (pulmonary
fibrosis) and because it scars the area, making surgical dissection
more difficult.
- Absolute alcohol as a sclerosing agent has been used with some
success in some patients; alcohol works well in vascular
malformations. Picibanil (OK-432) may be a viable option for large
unilocular cysts by themselves or for that component of the
lymphangioma. Currently, OK-432 is available in the United States only
by protocol. It does not work well for small cysts, which often occur
around the parotid area.
- Medical therapies also are being studied for in utero application.
This approach is appealing because it avoids the difficulties of
delivery of a child with a large cystic hygroma. In utero application
also decreases the possibility of airway obstruction in patients with
a neck cystic hygroma. This approach currently is performed only
experimentally and requires further study to document its safety and
efficacy.
Surgical Care
- The goal of performing surgical therapy is to remove the
lymphangioma completely or to remove as much lymphangioma as possible,
sparing all vital neurovascular structures.
- The exceptions to excision at the time of diagnosis are few and
include premature infants of small size and those with involvement of
crucial neurovascular structures that are small and difficult to
identify (eg, facial nerve).
- In such infants, delay surgery until the child is aged 2 years to
allow growth of the child to a size that facilitates surgical excision
without increased morbidity.
- Do not attempt drainage of the cyst because it increases the risk of
infection through possible contamination and causes increased
difficulty during resection because the thin walls of the cyst are not
located easily when not fluid filled.
- Surgical resection may be extensive, depending on the location of
the cystic hygroma and the invasion into local structures.
- Complications resulting from excision of a cystic hygroma include
damage to a neurovascular structure, chylous fistula, chylothorax, and
hemorrhage.”
http://www.emedicine.com/ped/topic536.htm
3) What is the prognosis?
From emedicine:
“Recurrence following complete resection is approximately 10%;
however, cystic hygromas can be expected to recur if residual disease
remains.
The goal of performing surgery is to completely remove the cystic
hygroma or to remove as much disease as possible, sparing all vital
structures.
In these cases, unroof the cystic structures and cauterize them if
possible, with the desire that scarring promotes involution of the
cystic hygroma. Cystic hygromas may have clinically inapparent
extensions at surgery that may contribute to recurrence.
Following therapy, monitor these children regularly with physical
examination.
Ultrasound can be used in areas that are not accessible by physical
examination or in the case of suspected recurrence; however MRI is
more effective than ultrasound.
Resect the cystic hygroma to the greatest extent possible when
clinically apparent.”
http://www.emedicine.com/ped/topic536.htm
From Medline Plus Medical Encyclopedia:
“The prognosis is good if complete resection is possible. In cases
where complete resection is not possible because of involvement of
neighboring nerves or blood vessels, recurrence is common.”
http://www.nlm.nih.gov/medlineplus/ency/article/000148.htm
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.
Thanks,
Kevin, M.D.
Links:
Emedicine gives two good review articles:
http://www.emedicine.com/radio/topic205.htm
and
http://www.emedicine.com/ped/topic536.htm
Medline Plus Medical Encyclopedia
http://www.nlm.nih.gov/medlineplus/ency/article/000148.htm
Search strategy using Google:
Hygroma treatment prognosis |
Clarification of Answer by
kevinmd-ga
on
22 Dec 2002 10:13 PST
Hello,
Thanks for your request for clarification:
"please clarify as to treatment an prognosis when per a ct scan of the
brain the bifrontal hygromas are indicated on the frontal lobe of the
brain of a four month old boy? please advise."
I didn't quite understand what exactly you are trying to ask. I think
you wanted clarification on prognosis.
I must first state that I cannot comment on your individual case as I
am neither a neurosurgeon or a pediatrician. As you can understand, I
cannot give advice on your individual case without seeing the X-rays,
the doctor's notes, and consulting with your physicians. I can only
answer factual questions.
Here are some comments regarding prognosis in general:
"Recurrence rate after surgical excision: 10-15%"
http://www.fpnotebook.com/ENT62.htm
"Outcome and prognosis relate to age of onset, the number of sites
affected, the size of the lesion, the location of the lesion, and
cosmetic implications. Negative prognostic factors include an age of
onset at younger than 1 year, multiple lesion sites, large complex
lesions, severe widespread cosmetic changes with extension into
subcutaneous tissues, and incomplete excision. Lesions of the lip,
tongue, floor of the mouth, and larynx/hypopharynx have a high rate of
recurrence. The mortality rate is less than 6%."
http://www.emedicine.com/ent/topic575.htm
"The treatment of choice is surgical excision but this can be
technically demanding, especially if an intra-thoracic extension is
present. There is a 15% recurrence rate if the lesion is not fully
excised. Laparoscopic techniques have been used in both diagnosis and
treatment of retroperitoneal cystic hygromas; laser therapy for
oropharyngeal extension has been used to good effect."
http://216.239.39.100/search?q=cache:uxFm_lQSaOoC:www.rcsed.ac.uk/journal/old/4410015.htm+hygroma+prognosis+children&hl=en&start=14&ie=UTF-8
"Recurrence following complete resection is approximately 10%;
however, cystic hygromas can be expected to recur if residual disease
remains."
http://author.emedicine.com/PED/topic536.htm
As you can see, recurrence of the hygroma is approximately 10-15%
following complete resection. Without seeing X-rays or physicians'
notes on the case, I cannot comment on the possibility of resecting
bifrontal hygromas on the frontal lobe of the brain of a four month
old boy - that is a question for a pediatric neurosurgeon who is
familiar with the case.
Thanks,
Kevin, M.D.
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