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Alokaili RN, Alokaili HR, Badran MF, Aldahash HA, Binkhamis SM. Snowballing Technique for High Flow Arteriovenous Fistula: A Technical Note. Neurointervention 2022; 17:50-53. [PMID: 35124941 PMCID: PMC8891581 DOI: 10.5469/neuroint.2021.00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 01/23/2022] [Indexed: 12/03/2022] Open
Abstract
A novel endovascular technique to occlude high flow direct arteriovenous fistulae is presented, where the distal tip of the microcatheter acts as a nucleus that the operator can grow a plug from a liquid embolic agent. Its advantages (such as cost-saving and distal reachability), disadvantages (such as embolic material instability), and technique are discussed.
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Affiliation(s)
- Riyadh Nasser Alokaili
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mohammad F Badran
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Homoud Abdulaziz Aldahash
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shagran M Binkhamis
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Parenrengi MA, Suryaningtyas W, Fauza J. Endovascular embolization for cases of 'hidden' pediatric cerebral arteriovenous malformations: A diagnostic & therapeutic challenge. Int J Surg Case Rep 2021; 86:106347. [PMID: 34481131 PMCID: PMC8416958 DOI: 10.1016/j.ijscr.2021.106347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ruptured arteriovenous malformations (AVM) hold a larger proportion as the cause of spontaneous intracranial hemorrhage in children compared to those in adults. Although surgical excision still remains as the gold standard therapy for arteriovenous malformations, some smaller ones are reported to resolve from embolization alone. However, difficulty arises when small arteriovenous malformations are not detected on certain diagnostic modalities such as Computed Tomography Angiography (CTA), giving rise to false negatives, which may compromise appropriate management of patients. Endovascular embolization can be used as alternative options as diagnostic and therapy for invisible arteriovenous malformation in children. We report two cases of ruptured paediatrics arteriovenous malformations with a complication of hydrocephalus, managed with endovascular embolization and a cerebrospinal fluid diversionary procedure. CASE DESCRIPTION We report 2 case in from Dr. Soetomo academic general hospital in 2021, the first case was a fully conscious 6-year-old-female child with sudden left-sided weakness and severe headache in January, and the second case a 9-year-old female came with decreased consciousness in May. Both had evidence of intracerebral hemorrhage, intraventricular hemorrhage, and hydrocephalus on head radiological examination, but no visible vascular malformations on Computed Tomography Angiography. The first patient was treated with extra ventricular drainage initially, while the second case was not. Transfemoral cerebral angiography revealed small arteriovenous malformations in both patients, and both had successful endovascular embolization afterwards. The first case was shunt-free, while the second case had her drainage switched to ventriculoperitoneal shunt right after the embolization procedure. Both patients recovered fully without complications and sequelae, and were discharged afterwards. DISCUSSION Both patients did not undergo surgical resection of the arteriovenous malformations; the first case only underwent endovascular embolization, while the second case underwent embolization and ventriculoperitoneal shunting. The cases described here help highlight the irreplaceable role of Transfemoral Cerebral Angiography as a gold standard for cases for arteriovenous malformations compared to other modalities, such as Computed Tomography Angiography (CTA). Smaller arteriovenous malformations in paediatrics are reported to achieve complete radiological resolution, and cerebrospinal fluid diversion in hydrocephalic cases are not always performed. Several factors to be considered include initial consciousness and severity of neurological deficit, which were taken into account in the management of our patients. CONCLUSION Embolization procedures may be beneficial in some pediatric arteriovenous malformations, preferably in smaller ones that undetectable by angiography. Several factors such as the consciousness and neurological deficit upon initial presentation may help in the decision making of these cases.
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Affiliation(s)
- Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic General Hospital, Indonesia.
| | - Wihasto Suryaningtyas
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic General Hospital, Indonesia.
| | - Joandre Fauza
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic General Hospital, Indonesia.
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Alvarez H, Niazi MH, Loewenstein J, Quinsey CS. Neonatal bilateral cerebral high flow fistulae leading to detection of a HHT-family carrier. Interv Neuroradiol 2020; 27:547-552. [PMID: 33353465 DOI: 10.1177/1591019920981308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cerebral and spinal cord high-flow arteriovenous fistulae (HFAVF) are part of the spectrum of lesions found in Hereditary Hemorrhagic Telangiectasia (HHT). HFAVF consist of communications between large arteries and veins without interposed nidi or capillary transitions. The association between HHT and cerebral or spinal HFAVF in children has been reported and suggested as a potential marker for HHT. We present a newborn with bilateral intracranial HFAVF tested positive for HHT1 and belonging to a family non known for carrying a HHT mutation. We also review reported cases of neonates and infants with cerebral and spinal HFAVF emphasizing their associations with genetic syndromes. Our aim is to add a new case to the pertinent literature and emphasize the need for molecular testing in children with spinal or brain HFAVF.
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Affiliation(s)
- Hortensia Alvarez
- Division of Interventional Neuroradiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Muhammad H Niazi
- Division of Interventional Neuroradiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Joshua Loewenstein
- Department of Neurosurgery at the University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carolyn S Quinsey
- Department of Neurosurgery at the University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature. AJR Am J Roentgenol 2017; 208:505-516. [DOI: 10.2214/ajr.16.17326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Tolly BT, Kosky JL, Koht A, Hemmer LB. A Case Report of Onyx Pulmonary Arterial Embolism Contributing to Hypoxemia During Awake Craniotomy for Arteriovenous Malformation Resection. ACTA ACUST UNITED AC 2017; 8:86-88. [PMID: 28195862 DOI: 10.1213/xaa.0000000000000436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism. With awake arteriovenous malformation resection following adjunctive Onyx embolization becoming increasingly employed for lesions involving the eloquent cortex, anesthesiologists need to be aware of pulmonary migration of Onyx material as a potential contributor to significant perioperative hypoxemia.
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Affiliation(s)
- Brian T Tolly
- From the Departments of *Anesthesiology, †Neurology, and ‡Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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El-Ghanem M, Kass-Hout T, Kass-Hout O, Alderazi YJ, Amuluru K, Al-Mufti F, Prestigiacomo CJ, Gandhi CD. Arteriovenous Malformations in the Pediatric Population: Review of the Existing Literature. INTERVENTIONAL NEUROLOGY 2016; 5:218-225. [PMID: 27781052 DOI: 10.1159/000447605] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Arteriovenous malformations (AVMs) in the pediatric population are relatively rare but reportedly carry a higher rate of rupture than in adults. This could be due to the fact that most pediatric AVMs are only detected after rupture. We aimed to review the current literature regarding the natural history and the clinical outcome after multimodality AVM treatment in the pediatric population, as optimal management for pediatric AVMs remains controversial. A multidisciplinary approach using multimodality therapy if needed has been proved to be beneficial in approaching these lesions in all age groups. Microsurgical resection remains the gold standard for the treatment of all accessible pediatric AVMs. Embolization and radiosurgery should be considered as an adjunctive therapy. Embolization provides a useful adjunct therapy to microsurgery by preventing significant blood loss and to radiosurgery by decreasing the volume of the AVM. Radiosurgery has been described to provide an alternative treatment approach in certain circumstances either as a primary or adjuvant therapy.
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Affiliation(s)
- Mohammad El-Ghanem
- Department of Neurology, Pennsylvania State University, Hershey, Pa, N.Y., USA
| | - Tareq Kass-Hout
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA; Division of Neuro-Endovascular Surgery, Department of Surgery, Rochester Regional Health System, Rochester, N.Y., USA
| | - Omar Kass-Hout
- Department of Neurology, Emory University School of Medicine, Atlanta, Va, N.Y., USA
| | - Yazan J Alderazi
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Krishna Amuluru
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
| | - Chirag D Gandhi
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J, N.Y., USA
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Clinical features and endovascular treatment of intracranial arteriovenous malformations in pediatric patients. Childs Nerv Syst 2014; 30:647-53. [PMID: 24013265 DOI: 10.1007/s00381-013-2277-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to characterize clinical features and evaluate the clinical outcome of endovascular embolization treatment intracranial arteriovenous malformations in pediatric patients. METHODS A cohort of children (age ≤ 18 years) with arteriovenous malformations (AVMs) from 2000 to 2012 was included. Predictors studied included patient gender, age, and angioarchitectural features, including AVM location, nidus morphology and size, venous drainage, and associated aneurysms. Treatment method, complications and outcomes were recorded. The features of AVMs were evaluated before the treatment. RESULTS One hundred twenty-seven children (77 males, mean age 13.2 years) were included; 90/127 (70.9 %) children were presented with hemorrhage. AVM size and deep venous drainage were independently associated with hemorrhage; 66/127 patients (52 %) treated with endovascular embolization. Complete obliteration at the end of all endovascular procedures was achieved in 14/66 patients (21.2 %), with an average of 78 % (range, 20-100 %) volume reduction. A mean of 2.9 (range, 1-9) feeding pedicles was embolized per patient. Overall, nine complications occurred in a total of 123 procedures (7.3 %). There was no procedure-related death in this study population. There was no significant difference between patients with and without complications in terms of AVM grade, demographic characteristics, or embolization features. CONCLUSIONS AVM size and deep venous drainage were independently associated with hemorrhage in pediatric patients. Endovascular procedure is feasible and safe for pediatric AVMs, and complete embolization can be achieved in small AVMs, while large AVMs can be adequately reduced in size for additional microsurgery or stereotactic radiosurgery.
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Soltanolkotabi M, Schoeneman SE, Alden TD, Hurley MC, Ansari SA, DiPatri AJ, Tomita T, Shaibani A. Onyx embolization of intracranial arteriovenous malformations in pediatric patients. J Neurosurg Pediatr 2013; 11:431-7. [PMID: 23394354 DOI: 10.3171/2013.1.peds12286] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors undertook this study to assess the safety and efficacy of Onyx embolization in the treatment of intracranial arteriovenous malformations (AVMs) in pediatric patients. METHODS All pediatric Onyx embolization of intracranial AVM cases performed consecutively at a single children's hospital over a 5-year period were collected and evaluated. RESULTS Twenty-five patients (mean age 10.5 years) underwent a total of 38 procedures. An aggregate of 56 pedicles were embolized (mean 1.47 per session). The Spetzler-Martin grade was determined in all cases. Onyx embolization resulted in complete obliteration of the AVM in 3 cases (12%) and partial obliteration in 22 cases (88%). A total of 23 patients underwent surgical treatment. The mean preoperative AVM devascularization in these cases was 72%. One patient was treated with radiosurgery following Onyx embolization. Overall, 10 complications occurred in a total of 38 procedures (26.3%). None of the complications resulted in permanent neurological morbidity. The rate of transient neurological complications was 10.5% (4 of 38 procedures) and the rate of transient nonneurological complications was 5.3% (2 of 38 procedures). The remaining 4 complications were clinically silent (rate of 10.5%). There were no procedure-related deaths in this study population. There was no significant difference in patients with and without complications in terms of demographic characteristics, AVM grade, or embolization features (p ≥ 0.2). Deep venous drainage was associated with higher complication rates (p = 0.03). CONCLUSIONS Onyx utilization is feasible for preoperative or primary embolization in the treatment of pediatric intracranial AVMs; however, the spectrum of complications encountered is broad, and attention must be paid to the technical nuances of and indications for its use to avoid many potential dangerous effects. Although the overall complication rates were higher than expected, all were either clinically silent or had only transient clinical effects. Thus, this experience suggests that Onyx embolization can be performed safely with a low rate of permanent morbidity in pediatric patients harboring these difficult lesions.
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Affiliation(s)
- Maryam Soltanolkotabi
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Ashour R, Aziz-Sultan MA, Soltanolkotabi M, Schoeneman SE, Alden TD, Hurley MC, Dipatri AJ, Tomita T, Elhammady MS, Shaibani A. Safety and Efficacy of Onyx Embolization for Pediatric Cranial and Spinal Vascular Lesions and Tumors. Neurosurgery 2012; 71:773-84. [DOI: 10.1227/neu.0b013e3182648db6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Although Onyx is widely used to embolize vascular lesions in adults, the safety and efficacy of this liquid embolic agent for use in children are not well studied.
OBJECTIVE:
To report our experience using Onyx in pediatric patients for a variety of cranial and spinal vascular lesions and tumors to determine its procedural complication rates, types, and clinical consequences and to highlight the indications for and principles of Onyx embolization in pediatric patients.
METHODS:
All pediatric Onyx embolization cases performed consecutively by the neuroendovascular services at our 2 institutions over a 5-year period were collected retrospectively and analyzed.
RESULTS:
Over the study period, 105 Onyx embolization procedures were performed in 69 pediatric patients with a mean follow-up of 112 days. Fifty-two patients harbored “primary” vascular lesions (malformations, fistulas, etc), whereas 17 patients had tumors. Complications occurred in 25 of 105 procedures (23.8%) and included ischemic infarct (7), asymptomatic nontarget embolization (4), intracerebral hemorrhage (3), microcatheter-related vessel perforation (3), retained microcatheter (2), cerebral edema (2), dimethyl sulfoxide-induced pulmonary edema (2), facial ischemia (1), and contrast-induced bronchospasm (1). Neurological morbidity occurred transiently after 10 procedures (9.5%) and permanently after 2 procedures (1.9%). There were no procedure-related deaths. Statistical analysis revealed no predictors of complications among the multiple potential risk factors evaluated.
CONCLUSION:
Our experience suggests that Onyx can be used effectively for embolization of pediatric cranial and spinal vascular lesions and tumors with low permanent morbidity; however, attention must be paid to the technical nuances of and indications for its use to avoid potential complications.
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Affiliation(s)
- Ramsey Ashour
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Mohammad Ali Aziz-Sultan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Maryam Soltanolkotabi
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samantha E. Schoeneman
- Department of Medical Imaging, Children's Memorial Hospital, Children's Memorial Hospital, Chicago, Illinois
| | - Tord D. Alden
- Division of Neurosurgery, Children's Memorial Hospital, Chicago, Illinois
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael C. Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arthur J. Dipatri
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Neurosurgery, Children's Memorial Hospital, Chicago, Illinois
| | - Tadanori Tomita
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Neurosurgery, Children's Memorial Hospital, Chicago, Illinois
| | - Mohamed Samy Elhammady
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Shaibani
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Pukenas BA, Satti SR, Bailey R, Weigele JB, Hurst RW, Stiefel MF. Onyx pulmonary artery embolization after treatment of a low-flow dural arteriovenous fistula: case report. Neurosurgery 2012; 68:E1497-500; discussion E1500. [PMID: 21307786 DOI: 10.1227/neu.0b013e318210c83b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Endovascular management of dural arteriovenous fistulas (DAVFs) has become an accepted primary and often definitive therapy. We present the first documented case of Onyx pulmonary embolism after embolization of a low-flow DAVF. CLINICAL PRESENTATION A 63-year-old man presented with subarachnoid hemorrhage secondary to a DAVF. Computed tomographic angiography, magnetic resonance imaging, and initial conventional angiogram were negative. A repeat angiogram demonstrated a DAVF, which was cured with Onyx embolization. A routine chest computed tomography after intervention revealed an asymptomatic Onyx embolization cast in a subsegmental pulmonary artery. CONCLUSION Endovascular treatment options include transarterial embolization with microcoils, polyvinyl alcohol particles, n-butyl-2cyanoacrylate, and Onyx (ev3 Neurovascular, Irvine, California). Complications associated with the use of Onyx are low but include embolizate pulmonary embolism. Patients often remain asymptomatic, but for symptomatic patients, conservative treatment options usually result in resolution of symptoms.
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Affiliation(s)
- Bryan A Pukenas
- Department of Radiology, Division of Interventional Neuroradiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
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Thiex R, Williams A, Smith E, Scott RM, Orbach DB. The use of Onyx for embolization of central nervous system arteriovenous lesions in pediatric patients. AJNR Am J Neuroradiol 2009; 31:112-20. [PMID: 19749215 DOI: 10.3174/ajnr.a1786] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of Onyx for the embolization of central nervous system (CNS) arteriovenous (AV) lesions have been widely reported in adults. However, data describing the use of this agent in children are limited. This study presents our experience with Onyx in the treatment of CNS AV lesions in pediatric patients. MATERIALS AND METHODS We retrospectively analyzed clinical and imaging records of 15 pediatric patients who underwent 36 transarterial embolizations by using Onyx for CNS AV lesions, from March 2007 through April 2009 at our institution. Underlying pathologies included brain AV malformations (AVMs) (n = 7), vein of Galen malformations (n = 4), dural AV fistulas (n = 2), and spinal AVMs (n = 2). For 7 procedures in very high-flow lesions, detachable coils were deployed before Onyx embolization, whereas in 29 procedures, Onyx was the sole embolic agent. The efficacy of embolization was judged by the residuum of AV shunting within the target region. RESULTS Embolization was complete in 2 patients, nearly complete in 9 patients, and partial (and ongoing) in 4 patients. Following staged embolization, 7 patients underwent surgical resection without significant blood loss and with good functional outcome in all cases. Clinically silent non-target embolization was encountered in 2 of 36 procedures. After 3 of the 36 embolizations, patients developed transient neurologic symptoms, all of which resolved to baseline within 24 hours. There were no non-neurologic adverse events. There was no imaging evidence of infarct or hemorrhage. CONCLUSIONS Onyx embolization of pediatric CNS AV lesions can be an efficacious treatment technique, with extremely low associated morbidity.
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Affiliation(s)
- R Thiex
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Jiang Y, Li Y, Wu Z. Onyx distal embolization in transarterial embolization of dural arteriovenous fistula with subtotally isolated transverse-sigmoid sinus. A case report. Interv Neuroradiol 2009; 15:223-8. [PMID: 20465904 DOI: 10.1177/159101990901500215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 04/26/2009] [Indexed: 11/15/2022] Open
Abstract
SUMMARY We describe a 39-year-old woman with dural arteriovenous fistula in the region of transversesigmoid sinus.A combination approach was designed to treat the fistula but the balloon failed to pass the severely stenosed proximal end of a subtotally isolated sinus. Although successfully occlusion of most feeding arteries from a single arterial injection was achieved, Onyx was found to shift to the outflow tract of the right heart ventricle and then to the lung latterly on six month follow-up.
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Affiliation(s)
- Y Jiang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, the People's Republic of China -
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Severe pulmonary oedema following therapeutic embolization with Onyx for cerebral arteriovenous malformation. Neuroradiology 2008; 50:439-42. [PMID: 18172630 DOI: 10.1007/s00234-007-0348-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 11/27/2007] [Indexed: 10/22/2022]
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