{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:40:37Z","timestamp":1776058837516,"version":"3.50.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Recently, Bleomycin-Electrosclerotherapy (BEST) has emerged as a novel alternative in the treatment of slow-flow vascular malformations. Regarding the commonly affected head and neck area, this procedure has to be safe and controllable due to the close anatomical proximity of critical structures. The aim of this study is to evaluate the safety and clinical outcome of BEST for slow-flow vascular malformations of the head and neck region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-five patients with symptomatic predominantly superficial SFVMs were treated by 41 BEST sessions between 11\/21 and 09\/24. Treatments of lesions involving the aerodigestive tract were excluded. Patient records and imaging findings were analyzed with respect to clinical and procedural details. Changes in overall symptom severity were classified into five categories (complete-, marked-, mild-, no response, and progress) based on patients\u2019 reports. Pre- and postprocedural lesion size was determined by measuring the maximum diameter in three orthogonal planes on MRI. Complications and side-effects including skin discoloration were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The most common indications for treatment were swelling in 17\/25 patients (68%), followed by pain (7\/25, 28%), and functional impairment (7\/25, 28%). Patients received 1.6\u202f\u00b1\u202f1.1 BEST sessions with a median bleomycin dose of 5\u202fmg (range 1\u201315\u202fmg). Complete response at the end of follow-up was observed in 8\/25 (32%), strong reduction of symptoms in 14\/25 (56%), and mild reduction in 3\/25 (12%) patients. No patients showed progression or were non-responders. Follow-up MRI revealed a lesion size reduction in all patients for which a follow-up MRI was available and complete or partial reduced contrast uptake in 8\/10 (80%) patients. Prolonged pain and swelling were observed after 4\/41 (9.8%) of BEST sessions. There were no major complications following the treatment of superficial SFVMs, especially no nerve injury. Skin discoloration was observed in 9\/25 (36%) of patients while all patients already reported partially fading during follow-up. All complications were temporary only and subsided at follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>BEST is safe and effective for treating slow-flow vascular malformations of the head and neck region with an acceptable risk- and complication profile.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1826764","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T04:40:43Z","timestamp":1776055243000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bleomycin-Electrosclerotherapy in the treatment of superficial slow-flow vascular malformations of head and neck"],"prefix":"10.3389","volume":"17","author":[{"given":"Florian","family":"Obereisenbuchner","sequence":"first","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline T.","family":"Seebauer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital","place":["Lucerne, Switzerland"]},{"name":"Department of Otorhinolaryngology, Regensburg University Medical Center","place":["Regensburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Borisch","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Puhr-Westerheide","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinan","family":"Deniz","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alena","family":"Sint","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natascha","family":"Platz Batista da Silva","sequence":"additional","affiliation":[{"name":"Department for Radiology and Neuroradiology, RoMed Hospital Rosenheim","place":["Rosenheim, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronika","family":"Vielsmeier","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Regensburg University Medical Center","place":["Regensburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"K\u00fchnel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Regensburg University Medical Center","place":["Regensburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix H.","family":"Vollbach","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Haehl","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Department of Paediatric Surgery, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Hartl","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Department of Paediatric Surgery, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter A.","family":"Wohlgemuth","sequence":"additional","affiliation":[{"name":"Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg","place":["Halle, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Ricke","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Seidensticker","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"Wildgruber","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa F.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Radiology, LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]},{"name":"Interdisciplinary Center for Vascular Anomalies (IZGA), LMU University Hospital, LMU Munich","place":["M\u00fcnchen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e113","DOI":"10.1097\/JOVA.0000000000000113","article-title":"Updated classification of vascular anomalies: a living document from the International Society for the Study of vascular anomalies classification 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