Minimal Invasive Management of Lymphatic Malformations

Lymphatic malformations are low-flow vascular anomalies that can develop anywhere in the body. Accurate diagnosis is essential before any therapeutic plan is executed, because combined vascular malformations and other conditions that mimic these lesions are frequent. Consequently, multidisciplinary evaluation of each case should be the standard of care and an indicator of good praxis. During the last decades, traditional wide surgical excision has been substituted by percutaneous sclerotherapy with different agents as the preferred approach. However, surgery still plays a significant role in certain patients. Minimal invasive techniques, through different approaches (thoracoscopy, laparoscopy, subcutaneoscopy, and, even, fetoscopy) alone or combined with sclerotherapy, have become an excellent option for selected cases of these complex malformations, which can associate severe complications and life-threatening events. Combination with endoscopic techniques (bronchoscopy, digestive endoscopy), for diagnostic and therapeutic purposes, is another valuable tool. Special mentions deserve prenatal and perinatal management of some lesions. Recent studies suggest that some pharmacological agents, like sirolimus, might have a role in the treatment of lymphatic malformations and should be considered as an option in the most severe unresectable cases.