Efficacy and Safety of Ethanol Ablation for Branchial Cleft Cysts

Abstract

Background and purpose: Branchial cleft cyst is a common congenital lesion of the neck. This study evaluated the efficacy and safety of ethanol ablation as an alternative treatment to surgery for branchial cleft cyst.

Materials and methods: Between September 2006 and October 2016, ethanol ablation was performed in 22 patients who refused an operation for a second branchial cleft cyst. After the exclusion of 2 patients who were lost to follow-up, the data of 20 patients were retrospectively evaluated. All index masses were confirmed as benign before treatment. Sonography-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%) into the lesion. The injected volume of ethanol was 50%-80% of the volume of fluid aspirated. Therapeutic outcome, including the volume reduction ratio, therapeutic success rate (volume reduction ratio of >50% and/or no palpable mass), and complications, was evaluated.

Results: The mean index volume of the cysts was 26.4 ± 15.7 mL (range, 3.8-49.9 mL). After ablation, the mean volume of the cysts decreased to 1.2 ± 1.1 mL (range, 0.0-3.5 mL). The mean volume reduction ratio at last follow-up was 93.9% ± 7.9% (range, 75.5%-100.0%; P < .001). Therapeutic success was achieved in all nodules (20/20, 100%), and the symptomatic (P < .001) and cosmetic (P < .001) scores had improved significantly by the last follow-up. In 1 patient, intracystic hemorrhage developed during the aspiration; however, no major complications occurred in any patient.

Conclusions: Ethanol ablation is an effective and safe treatment for patients with branchial cleft cysts who refuse, or are ineligible for, an operation.

Fig 1.

Flowchart of the patient enrollment process.

Fig 2.

A 22-year-old woman with a right-neck mass. A, A CT scan reveals a 6.5-cm second branchial cleft cyst anteromedial to the sternocleidomastoid muscle and lateral to the carotid sheath. B, After 3 sessions of ethanol ablation, it is nearly obliterated on follow-up CT (arrow). C and D, Transverse sonogram also shows a large cystic mass in the right neck (volume, 48.1 mL) nearly disappeared after the treatment (arrow).

Fig 3.

A 15-year-old adolescent boy with a right-neck mass. A and B, Transverse US and CT scans show a 7-cm cystic mass in the right neck (volume, 36.6 mL). C, During the ethanol ablation, intracystic hemorrhage developed after aspiration of internal contents. D, However, after a second session of ethanol ablation, the cystic mass had disappeared on follow-up US (arrow).