Background Modified Electro-Sclero Therapy (MEST) has recently been introduced as an effective treatment for large extracranial arteriovenous malformations (AVMs), particularly SECg stage S3 lesions, achieving reliable devascularization with stable results. However, in a subset of patients presenting with long-standing disease, AVMs can be associated with significant soft-tissue overgrowth and deformity, and removal of the diseased vascular component alone may be insufficient to restore normal anatomy. Objectives To evaluate outcomes of a staged treatment strategy consisting of MEST followed by surgical correction in patients with AVMs associated with tissue overgrowth, and to clarify the complementary roles of both modalities. Materials and methods Eight consecutive patients with extracranial AVMs of the head and neck and clinically significant soft-tissue hypertrophy were treated with MEST according to a previously published protocol. After confirmation of complete AVM devascularization, patients underwent surgery aimed exclusively at correction of residual overgrowth and contour deformity. Results MEST achieved complete devascularization in all patients. Only minimal or no clinically meaningful reduction of established tissue overgrowth was observed after MEST alone. Subsequent surgery allowed safe resection and remodeling of hypertrophic tissues, resulting in restoration of normal or near-normal facial and oral anatomy. No major perioperative complications or recurrences were observed. Conclusions In AVMs associated with tissue overgrowth, MEST and surgery address different components of the disease. MEST provides vascular control, while surgery corrects irreversible structural sequelae. Their combination represents a rational and reproducible treatment paradigm.
Giacomo Colletti (Wed,) studied this question.